Manager Compliance Coding

Texas Health Resources•Arlington, TX

2d•Hybrid

About The Position

The Coding Compliance Manager 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 policies. It analyzes audit data, identifies areas of concern, 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 tailored to executive leadership and other stakeholders. The position serves as a resource to providers, HIMS, the Central Billing Office, and other departments on coding compliance, documentation standards, and applicable federal, state, and Texas Health/THPG regulations. It leads the coding audit team, works across departments and with vendors, supports regulatory education and research, and conducts or oversees coding, documentation, billing, and compliance audits, including follow-up reviews when significant risks are identified.

Requirements

Bachelor's degree required.
Six years of experience conducting compliance coding and billing audits, including supervising and managing coding or auditing in a medium-to-large healthcare system; experience must include supervisory and/or leadership experience.
Upon hire, hold one of the following certifications: 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.
Expertise in planning, scheduling, and overseeing projects.
Exceptional oral and written communication skills for conveying 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 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 Microsoft Office products, including Excel, Word, and PowerPoint.
Ability to provide constructive feedback and translate complex coding rules into actionable insights for coders, non-coders, and senior leadership.
Ability to work autonomously, meet deadlines, and apply 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.
Provider engagement experience.
People leadership experience.
CHC (Certification in Healthcare Compliance).

Responsibilities

Work with departments to align compliance practices with regulatory guidance and industry standards.
Identify compliance risks, report findings, and recommend corrective actions.
Monitor regulatory changes and industry standards to support ongoing compliance.
Support the Director in developing the annual work plan for compliance and audit effectiveness.
Educate the audit team, coding staff, and relevant departments on CMS, Medicaid, payer, and other regulatory requirements.
Provide feedback on billing and documentation procedures, address conflicting or vague documentation, and recommend coding education and best practices.
Conduct additional reviews to support departments handling Medicare, OIG, or non-Medicare denials, providing analysis of coding, documentation, and regulatory guidance.
Research and respond to departmental coding, documentation, and compliance inquiries using applicable federal, state, local, and Texas Health policies.
Lead the coding audit team, including training and performance evaluation.
Monitor vendor performance and contractual compliance, collaborate with vendors on audits, escalate issues, and ensure findings and action items are resolved within required timeframes.
Conduct internal compliance audit testing and evaluate internal controls and compliance procedures.
Assist with inpatient, outpatient, and provider coding assessments to confirm codes are supported by documentation and comply with applicable policies.
Perform second-level reviews of organizational billing performance for compliance with legal and regulatory requirements.
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.
Perform other duties as assigned.