Compliance Officer – HIPAA, Prior Authorization & Billing

About the role

We are seeking a Compliance Officer to own the regulatory backbone of our healthcare operations. This high‑impact position sits at the intersection of patient privacy, payer regulations, and revenue integrity, ensuring audits are clean and documentation is flawless.

Key responsibilities

• Develop, implement, and enforce policies that protect patient data under HIPAA Privacy & Security Rules.
• Maintain audit‑ready prior‑authorization workflows and ensure compliance with CMS, OIG, OCR, and commercial payer requirements.
• Oversee medical billing and coding practices to meet federal, state, and payer standards (ICD‑10, CPT, HCPCS).
• Conduct risk assessments, internal audits, and breach investigations, reporting findings to leadership.
• Collaborate with EHR/EMR teams and claims platforms to embed compliance controls.

Required profile

• Bachelor’s degree in Healthcare Administration, Nursing, Law, Business, or a related field.
• 5+ years of compliance experience in a healthcare, payer, or revenue‑cycle environment.
• Deep knowledge of HIPAA, prior‑authorization regulations, and U.S. medical billing/coding standards.
• Proven ability to write clear policies and audit responses that satisfy regulators.
• Strong judgment, discretion, and willingness to escalate uncomfortable findings.

Required skills

• ICD‑10, CPT, HCPCS coding standards.
• Experience with EHR/EMR systems such as Epic, Cerner, and athenahealth.
• Familiarity with claims platforms and GRC (Governance, Risk, and Compliance) tools.