Manager, Coding & Billing Integrity
Description:
• Perform chart reviews to ensure proper ICD-10, CPT, and HCC coding across professional services.
• Educate providers on documentation standards for E/M leveling, time-based billing, and HCC coding.
• Partner with clinical leadership to improve diagnosis specificity and close coding gaps.
• Ensure alignment between clinical documentation, coding, and claim submission.
• Monitor modifier usage, place-of-service accuracy, and billing edits to reduce denials.
• Review pre-bill and post-bill data to catch errors before claims are submitted.
• Collaborate with the billing team to respond to coding-related denials and payer inquiries.
• Conduct internal audits to measure documentation quality, coding accuracy, and billing compliance.
• Prepare reporting for leadership on trends, risk areas, and financial impact.
• Stay current on CMS guidelines, payer policies, and code set changes; update internal teams accordingly.
• Work closely with the VP of Revenue Cycle, compliance team, providers, and external coders.
• Create and lead training sessions and materials for clinical and billing staff.
• Support risk adjustment and value-based care initiatives with coding expertise and documentation insight.
Requirements:
• Bachelor’s degree in Health Information Management, Healthcare Administration, or related field preferred
• CPC (Certified Professional Coder) mandatory
• One or more of: CRC, CPMA, CCS-P, RHIT, or RHIA
• 5+ years of experience in medical coding, documentation review, and billing compliance—focused on primary care services and nursing homes
• 3+ years in a senior-level coding or billing position (lead or supervisory role preferred)
• Strong knowledge of risk adjustment (HCC/RAF) and E/M coding
• Strong interpersonal and communication skills, with a proven ability to foster cross-departmental collaboration.
Benefits:
• 401k with employer match
• Comprehensive health, dental, and vision insurance
• Paid time off (PTO)
• Employer-paid life insurance policy
Apply Now
Apply Now
• Perform chart reviews to ensure proper ICD-10, CPT, and HCC coding across professional services.
• Educate providers on documentation standards for E/M leveling, time-based billing, and HCC coding.
• Partner with clinical leadership to improve diagnosis specificity and close coding gaps.
• Ensure alignment between clinical documentation, coding, and claim submission.
• Monitor modifier usage, place-of-service accuracy, and billing edits to reduce denials.
• Review pre-bill and post-bill data to catch errors before claims are submitted.
• Collaborate with the billing team to respond to coding-related denials and payer inquiries.
• Conduct internal audits to measure documentation quality, coding accuracy, and billing compliance.
• Prepare reporting for leadership on trends, risk areas, and financial impact.
• Stay current on CMS guidelines, payer policies, and code set changes; update internal teams accordingly.
• Work closely with the VP of Revenue Cycle, compliance team, providers, and external coders.
• Create and lead training sessions and materials for clinical and billing staff.
• Support risk adjustment and value-based care initiatives with coding expertise and documentation insight.
Requirements:
• Bachelor’s degree in Health Information Management, Healthcare Administration, or related field preferred
• CPC (Certified Professional Coder) mandatory
• One or more of: CRC, CPMA, CCS-P, RHIT, or RHIA
• 5+ years of experience in medical coding, documentation review, and billing compliance—focused on primary care services and nursing homes
• 3+ years in a senior-level coding or billing position (lead or supervisory role preferred)
• Strong knowledge of risk adjustment (HCC/RAF) and E/M coding
• Strong interpersonal and communication skills, with a proven ability to foster cross-departmental collaboration.
Benefits:
• 401k with employer match
• Comprehensive health, dental, and vision insurance
• Paid time off (PTO)
• Employer-paid life insurance policy
Apply Now
Apply Now