Manager Compliance Coding

#REF!•Arlington, TX

About The Position

The Coding Compliance Manager oversees and manages auditing and monitoring activities related to billing and coding compliance. This role is responsible for developing policies, procedures, and risk-based educational materials to ensure adherence to federal and state regulations, as well as THR policies. Key responsibilities include analyzing audit data to identify areas of concern, collaborating with auditees, providers, and leadership to guide rebuttals, and establishing management correction plans when necessary. Additionally, the Compliance Auditor Manager effectively communicates audit findings through reports, presentations, and educational materials tailored for executive leadership and relevant stakeholders. Serving as a trusted resource, this position provides guidance to providers, HIMS, the Central Billing Office, and other departments regarding coding compliance, documentation standards, and applicable federal, state, and THR/THPG regulations.

Requirements

Bachelor's Degree Required
6 Years Experience in conducting compliance coding and billing audits including supervising and managing coding/auditing in a medium to large healthcare system. Must include supervisory and/or leadership experience.
RHIT - Registered Health Information Technician Upon Hire Required
Or RHIA - Registered Health Information Administrator Upon Hire Required
Or CCS - Certified Coding Specialist Upon Hire Required
Or CPC - Certified Professional Coder Upon Hire Required
Strong understanding of leadership principles and best practices in team management, direction, and development.
Expertise in planning, scheduling, and overseeing projects to drive operational efficiency.
Exceptional oral and written communication skills to effectively convey complex regulatory and compliance concepts.
Ability to analyze data, identify trends, and recommend solutions for complex compliance and coding challenges.
Extensive knowledge of MS DRG, APC, ICD-10-CM/PCS, CPT, HCPCS coding, modifiers, NCCI edits, and official coding guidelines.
Strong understanding of medical terminology, human anatomy and physiology, pathophysiology, and pharmacology.
Expertise in office and outpatient coding, report preparation, data analysis, and proficiency in Microsoft Office products (Excel, Word, and PowerPoint).
Ability to provide clear and constructive feedback to coders, non-coders, and senior leadership, translating complex coding rules into actionable insights.
Demonstrated ability to work autonomously, meet deadlines, and apply critical thinking skills in decision-making.
Strong listening skills and ability to train others, lead meetings, and facilitate education sessions.
Expertise in ensuring documentation accurately captures a patient's health status and clinical condition.
Proficiency in researching Medicare, OIG, CMS, and other regulatory sources to interpret policies and industry standards.

Responsibilities

Organization and Oversight
Cross-Department Collaboration - Work closely with various departments to align compliance practices with regulatory guidance and industry standards.
Risk Identification & Mitigation - Identify compliance risks, report findings, and recommend corrective actions to enhance regulatory compliance.
Regulatory Monitoring & Industry Best Practices - Stay informed on evolving regulations and industry standards, ensuring the organization remains compliant and proactive.
Strategic Planning Assistance - Support the Director in developing the annual work plan to strengthen compliance and audit effectiveness.
Regulatory Compliance & Education - Inform and educate the audit team, coding staff, and other relevant departments on regulatory requirements (CMS/Medicaid) and payer guidelines, ensuring compliance with evolving policies.
Billing & Documentation Policy Feedback - Provide feedback on billing and documentation procedures, addressing conflicting or vague documentation issues. Recommend coding education, training, and best practices for areas vulnerable to compliance errors.
Denial Support & Case Review - Conduct additional reviews to assist departments handling Medicare, OIG, or non-Medicare denials. Provide expert analysis on coding, documentation, and applicable regulatory guidance.
Regulatory Research & Guidance - Research coding, documentation, and compliance inquiries from various departments, offering timely guidance based on Federal, State, Local, and THR policies.
Coding Audit Team Management - Lead the coding audit team, including training and performance evaluation, to maintain high standards of efficiency and compliance.
Vendor Performance Management - Monitor and manage vendor performance to ensure compliance with contractual obligations, addressing and escalating issues as needed. Collaborate closely with vendors to conduct audits effectively and efficiently. Ensure that audit findings are reviewed thoroughly, documented, and all action items are resolved within the stipulated time frame.
Other duties as assigned.
Review, Auditing, and Monitoring
Conduct Compliance Audits - Perform internal audit testing to ensure adherence to regulatory requirements and organizational policies. Evaluate the effectiveness of internal controls and compliance procedures.
Coding & Documentation Review - Assist the audit team with inpatient, outpatient, and provider coding assessments to ensure assigned codes are supported by proper documentation and adhere to Federal, State, Local, and THR policies.
Billing Performance Review - Perform second-level reviews of the organization’s billing performance, verifying compliance with legal policies and regulatory requirements that pose operational risk.
Audit Reporting & Presentation - Prepare detailed audit reports and present findings to senior leadership, Texas Health management, and relevant committees, ensuring transparency in billing audits.
Follow-Up Audits & Risk Assessment - Conduct follow-up audits when findings indicate significant compliance risks, ensuring corrective actions are effectively implemented.