QA Compliance Specialist I, HIM

About Us: The people of Memorial Sloan Kettering Cancer Center (MSK) are united by a singular mission: ending cancer for life. Our specialized care teams provide personalized, compassionate, expert care to patients of all ages. Informed by basic research done at our Sloan Kettering Institute, scientists across MSK collaborate to conduct innovative translational and clinical research that is driving a revolution in our understanding of cancer as a disease and improving the ability to prevent, diagnose, and treat it. MSK is dedicated to training the next generation of scientists and clinicians, who go on to pursue our mission at MSK and around the globe. Exciting Opportunity at MSK: QA Compliance Specialist I, HIM At Memorial Sloan Kettering, every role contributes to advancing world-class patient care, research, and operational excellence. As a QA Compliance Specialist within Health Information Management , you’ll ensure the accuracy, integrity, and regulatory compliance of clinical documentation and coding—strengthening revenue integrity, audit readiness, and data quality while supporting MSK’s mission to end cancer for life. Role Overview Perform compliance reviews and formal audits validating ICD-10-CM/PCS, CPT-4, modifiers, Facility Evaluation & Management, and medication administration coding. Ensure accurate coding and charge capture aligned with CMS, third-party payer, JCAHO, and HIPAA regulatory standards. Identify documentation gaps, trends, and risks impacting coding and billing accuracy, compliance, and audit outcomes. Communicate findings and recommendations to HIM leadership, clinical teams, Revenue Integrity and Patient Accounts partners. Coordinate and support external payer audits by preparing documentation and responding to data requests. Participate in special projects focused on data management, quality improvement, and process optimization. Maintain audit documentation, tracking tools, and reporting to support continuous compliance monitoring. Apply independent judgment while operating within defined objectives and regulatory frameworks. Promote corrective actions and process enhancements to strengthen coding quality and operational consistency. Review and track denials to ensure coding accuracy based on documentation and compliance with regulatory policies and standards. Key Qualifications Minimum of 3 years of experience in medical terminology, anatomy and physiology, hospital coding and billing, and medical records. Demonstrated expertise with ICD-10-CM/PCS, CPT, and Facility Evaluation & Management coding. Hands-on experience conducting coding audits, compliance reviews, and regulatory validation activities. Working knowledge of healthcare regulatory requirements, including CMS guidelines and HIPAA standards. Proficiency using PC applications such as Microsoft Excel and Word for reporting, analysis, and documentation. Core Skills Strong analytical and problem-solving abilities to identify trends, risks, and improvement opportunities in complex data sets. Clear, confident communication skills to present findings, provide guidance, and collaborate across multidisciplinary teams. High attention to detail and organizational discipline to manage large volumes of sensitive and complex information accurately. Ability to navigate multiple clinical, billing, and data systems while adapting to evolving workflows and regulations. Additional Information: Location: Hybrid; when on site 633 Third Avenue in NYC (on site 4x a year) Schedule: Monday – Friday, 9 am – 5 pm (flexibility to start as early as 6:30 am) Reporting to: Manager, Health Information Management Helpful Links : Compensation Philosophy Benefits Pay Range: $69,400.00 - $107,600.00 FSLA Status: Exempt Closing : At MSK, we believe in fair, competitive pay that reflects your job, experience, and skills. MSK is an equal opportunity and affirmative action employer committed to diversity and inclusion in all aspects of recruiting and employment. All qualified individuals are encouraged to apply and will receive consideration without regard to race, color, gender, gender identity or expression, sexual orientation, national origin, age, religion, creed, disability, veteran status or any other factor which cannot lawfully be used as a basis for an employment decision. Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.