Location: REMOTE
Employment Type: Full-Time
Reports to: CEO AND CGO
Position Summary:
Vital Healthcare is seeking a Manager of Coding and Compliance to oversee all aspects of medical coding, chart auditing, and compliance with Medicare and Medicaid regulations. This role is critical to ensuring accurate coding, billing, and documentation practices align with industry standards and regulatory requirements. The ideal candidate will have a strong background in medical coding, compliance, and regulatory affairs, particularly in behavioral health, endocrinology, PM&R, and multi-specialty medical services.
Key Responsibilities:
Compliance & Regulatory Oversight:
- Ensure all coding and billing practices comply with Medicare, Medicaid, and commercial insurance regulations.
- Stay updated on CMS guidelines, OIG compliance mandates, and state-specific regulations to ensure organizational adherence.
- Develop and implement compliance policies, procedures, and training programs for coding and documentation.
- Serve as the primary liaison for audits, compliance reviews, and payer inquiries.
- Conduct internal audits to identify potential risk areas and recommend corrective actions.
Medical Chart Auditing & Documentation Review:
- Perform regular chart audits to ensure proper documentation supports coding and billing.
- Provide feedback and education to clinicians regarding documentation best practices.
- Analyze coding trends and identify areas for improvement or risk mitigation.
- Collaborate with providers to ensure appropriate use of E/M codes, CPT codes, and HCPCS codes.
Billing & Reimbursement:
- Oversee coding accuracy for medical claims and work with the revenue cycle team to ensure proper reimbursement.
- Identify and address billing errors, denials, and appeals, working closely with the billing department.
- Ensure proper application of ICD-10, CPT, HCPCS, and modifier usage.
Training & Education:
- Develop and conduct coding and compliance training for providers and staff.
- Educate clinicians and administrative staff on coding updates, regulatory changes, and best practices.
- Ensure continuous professional development within the coding and compliance team.
Collaboration & Leadership:
- Work closely with clinical leadership, revenue cycle management, and legal teams to maintain compliance integrity.
- Assist in compliance reporting and audits to meet both internal and external regulatory requirements.
Qualifications:
- Experience: Minimum 5-7 years of experience in medical coding, auditing, and compliance in a multi-specialty medical practice.
- Certification: CPC (Certified Professional Coder), CPMA (Certified Professional Medical Auditor), or CCS (Certified Coding Specialist) preferred but not necessary
- Regulatory Expertise: In-depth knowledge of Medicare and Medicaid regulations, CMS guidelines, OIG compliance programs, and commercial payer policies.
- Technical Skills: Proficiency in EHR/EMR systems, coding software, billing platforms, and excel.
- Analytical Abilities: Strong problem-solving skills with the ability to interpret regulatory changes and implement compliance measures.
- Communication Skills: Excellent written and verbal communication to educate and collaborate with providers and staff.
- Leadership Experience: Prior management or supervisory experience is preferred.
Preferred Qualifications:
- Experience in behavioral health, endocrinology, PM&R, and multi-specialty medical services preferred.
- Knowledge of value-based care reimbursement models and risk adjustment coding.
- Familiarity with fraud, waste, and abuse regulations in healthcare compliance.
Compensation & Benefits:
- Competitive salary based on experience.
- Comprehensive health, dental, and vision insurance.
- 401(k) with employer match.
- Generous Paid time off/ Holidays
