Billing and Coding Manager - Fully Remote

Contributes to the company’s mission, vision and values by developing and managing the billing and coding processes. The Billing and Coding Manager implements improvements to the billing and collections activities and ensures revenue cycle compliance. This position is responsible for communication with clinicians, management and operation teams, and RCM department on a regular basis. This role is crucial in ensuring the accuracy and efficiency of our coding processes, compliance, and education. Additionally, a primary function of this role involves leading a proficient billing/collections team, managing the daily operations of the department, developing complex billing processes, and optimizing workflows.

ESSENTIAL FUNCTIONS:

· Serve as a resource for healthcare providers and staff on billing and coding issues, offering guidance and solutions.

· Provides direction to the RCM team regarding billing operations, billing and collection, coding and compliance, reimbursement and third-party contract compliance, and reporting.

· Coordinates with employees responsible for charge capture or entry, coding, reimbursement, or insurance verification to identify and resolve issues impacting billing or collections.

· Manage daily operations of the coding department, ensuring accurate and timely preparation and submission of claims

· Monitors, assesses and manages daily production

· Ensures compliance with all relevant reporting and data collection regulations.

· Tracks metrics to develop and implement strategies for improvement.

· Manages the policies, objectives, and initiatives of RCM activities to meet target operational and revenue goals.

· Provides training and education relative to regulatory and billing requirements.

· Oversee coding compliance and develop coding/billing protocols

· The training and education responsibilities of this position will include designing and developing billing/coding training modules, instructing current coders and coder trainees about coding guidelines, code changes and observed issues from the audits

· Manage an onshore and offshore billing and coding team

Key Responsibilities:

· Provide leadership and mentorship to the coding team, fostering a positive and productive work environment

· Supervise and coordinate all daily billing activities

· Lead weekly and end of month billing and charge reporting

· Develop and implement complex billing processes based on unique client requirements and business needs

· Proactively identify, develop, and execute solutions to enhance overall effectiveness and efficiency within billing and collections, including monitoring and assessing high risk and escalated account situations

· Lead special projects as assigned or through personal initiative.

· Stay updated with company policies, procedures, and practices; participate in ongoing training and development to ensure knowledge and skills remain current and comprehensive

· Conduct audits and reviews of coding processes to ensure compliance with regulations and best practices.

· Collaborate with the billing team to address insurance billing and claim denials.

· Develop and present educational tools and procedures for coders and providers.

· Stay current with industry trends and regulations to drive continuous improvement.

· Identify training needs and coordinate ongoing education opportunities to improve team expertise and capabilities

· Establish and maintain strong relationships with clients/practice brands, providing RCM support for inquiries and disputes on billing and coding

· Establish and maintain positive working relationships across departments, divisions, and locations.

· Actively involved in designing and developing training modules as a means of mentoring and training in all functions and services related to hospital medical coding, medical documentation, physician queries, electronic health record abstracting and data collection

QUALIFICATIONS: [Education, Training, Knowledge, Skills, Abilities, and Expected Behaviors]

Required:

• Podiatry experience preferred.
• Certified Professional Coder (CPC) certification is required.
• Must communicate logically and clearly both orally and in writing.
• Minimum of 5 years’ experience interpreting insurance explanation of benefits.
• Minimum of 3 years’ experience with medical claims, billing, payment posting and insurance collections.
• Extensive knowledge of ICD-10-CM and AMA CPT coding is required to perform the above functions
• Knowledge of all insurance guidelines especially Medicare and Medicaid according to standards.
• Knowledge of California payors, including IPAs is a plus
• Knowledge of legal, regulatory, and policy compliance issues related to medical coding and
• billing procedures and documentation.
• Experience with prior authorizations, pre-determinations, and out-of-network gap exceptions.
• Ability to supervise and mentor others.
• Ability to use independent judgment and to manage and impart confidential information.
• Additionally, applicant qualifications should include excellent analytical and communication skills
• Strong research skills including knowledge of automated analysis tools is required to resolve complex coding/systems issues
• Legal eligibility to work in the United States without sponsorship now or in the future.
• Ability to successfully pass a background investigation / pre-employment screening
• High School Diploma or equivalent.