Manager Compliance Coding

Texas Health•Arlington, TX

2d•Hybrid

About The Position

The Manager Compliance Coding oversees and manages auditing and monitoring activities related to billing and coding compliance. The role develops policies, procedures, and risk-based educational materials to support adherence to federal and state regulations and Texas Health Resources (THR) policies. It analyzes audit data to identify concerns, collaborates with auditees, providers, and leadership on rebuttals, and establishes management correction plans when needed. The manager communicates audit findings through reports, presentations, and educational materials for executive leadership and relevant stakeholders, and serves as a resource to providers, HIMS, the Central Billing Office, and other departments on coding compliance, documentation standards, and applicable regulations. The position leads the coding audit team, including training and performance evaluation, and works with internal departments and vendors to conduct effective audits, resolve findings, and complete action items on time. It performs compliance testing, coding and documentation assessments, billing reviews, and follow-up audits, and provides guidance on regulatory requirements, payer guidelines, coding, and documentation. The role also supports the Director in developing the annual work plan and presents audit findings to senior leadership, Texas Health management, and relevant committees. The position is based at Texas Health Resources, with core hours Monday through Friday, 8:00 a.m. to 5:00 p.m. A hybrid arrangement is available, typically with one in-office day on Tuesday.

Requirements

Bachelor's degree.
Six years of experience conducting compliance coding and billing audits, including supervising and managing coding or auditing in a medium to large healthcare system.
Supervisory and/or leadership experience.
One of the following certifications required upon hire: RHIT (Registered Health Information Technician), RHIA (Registered Health Information Administrator), CCS (Certified Coding Specialist), or CPC (Certified Professional Coder).
Strong understanding of leadership principles and team management, direction, and development.
Ability to plan, schedule, and oversee projects to promote operational efficiency.
Exceptional oral and written communication skills, including the ability to explain complex regulatory and compliance concepts.
Ability to analyze data, identify trends, and recommend solutions to complex compliance and coding challenges.
Extensive knowledge of MS-DRG, APC, ICD-10-CM/PCS, CPT, HCPCS, 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, and data analysis, with proficiency in Microsoft Office products, including Excel, Word, and PowerPoint.
Ability to provide constructive feedback to coders, non-coders, and senior leadership and translate complex coding rules into actionable insights.
Ability to work autonomously, meet deadlines, and use critical thinking 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.

Nice To Haves

Acute care hospital and provider office coding and auditing experience is strongly preferred.
Provider engagement experience is preferred.
People leadership experience is preferred.
CHC (Certification in Healthcare Compliance) is a plus.

Responsibilities

Collaborate across departments to align compliance practices with regulatory guidance and industry standards.
Identify compliance risks, report findings, and recommend corrective actions.
Monitor changing regulations and industry standards to support ongoing compliance.
Assist the Director with developing the annual work plan to strengthen compliance and audit effectiveness.
Educate the audit team, coding staff, and other departments on CMS and Medicaid requirements, payer guidelines, and evolving policies.
Provide feedback on billing and documentation procedures, including conflicting or unclear documentation, and recommend education and best practices for areas vulnerable to compliance errors.
Conduct additional reviews to support departments handling Medicare, OIG, and non-Medicare denials, providing analysis of coding, documentation, and applicable guidance.
Research coding, documentation, and compliance questions and provide timely guidance based on federal, state, local, and THR policies.
Lead the coding audit team, including training and performance evaluation.
Monitor vendor performance and contractual compliance, address or escalate issues, and collaborate with vendors on audits.
Ensure audit findings are thoroughly reviewed and documented and that action items are resolved within the stipulated timeframe.
Perform internal audit testing to assess adherence to regulatory requirements and organizational policies and evaluate internal controls and compliance procedures.
Assist with inpatient, outpatient, and provider coding assessments to verify that codes are supported by documentation and comply with applicable policies.
Conduct second-level reviews of billing performance for compliance with legal policies and regulatory requirements that pose operational risk.
Prepare audit reports and present findings to senior leadership, Texas Health management, and relevant committees.
Conduct follow-up audits when findings indicate significant compliance risks and verify corrective actions are implemented effectively.
Analyze audit data, collaborate with auditees, providers, and leadership on rebuttals, and establish management correction plans when necessary.
Perform other duties as assigned.