Manager of Coding & Revenue Integrity

Spire Orthopedic Partners•Stamford, CT

About The Position

The Revenue Integrity Manager oversees processes that ensure accurate coding compliance, billing integrity, reimbursement, and revenue cycle performance.

Requirements

Active coding certification required (CPC, CCS, CCS-P, COC, or equivalent).
Minimum 5 years of progressive experience in professional billing, revenue integrity, coding, or revenue cycle operations.
Minimum 3 years of leadership or supervisory experience.
Advanced knowledge of professional billing workflows, charge capture processes, payer reimbursement methodologies, and denial management.
Strong understanding of CPT, HCPCS, ICD-10-CM, and modifier application.
Demonstrated ability to analyze complex data sets and implement operational improvements.
Strong written and verbal communication skills with ability to engage physicians, operational leaders, and executives.

Nice To Haves

Bachelor’s degree preferred.
Equivalent experience may be considered.

Responsibilities

Onboarding new/additional coders to Spire Orthopedic Partners Coding Team, including: Participation in the interview process with Associate Director of Billing and Coding. Training/review all needed systems for newly hired certified coders. Monitor proficiency and accuracy of newly hired certified coders for 30 days.
Monitors charge capture processes to ensure accurate and timely billing.
Analyze billing edits, denials, underpayments, and reimbursement trends.
Ensure compliance with federal, state, and payer billing regulations.
Develop and maintain standardized professional billing workflows, coding policies, and applicable training as needed.
Monitor center coding volume and coder workload to ensure adequate workload distribution and to ensure that all completed charts are coded in a timely manner.
Establish back up plan/cross coverage (to address time off, unexpected team absences, etc.) to ensure that timely coding is maintained.
Partner with Coding, Billing, Compliance, IT, and Clinical Operations to ensure alignment of documentation, practice management workflows, and payer requirements.
Provide in collaboration with Director of Billing and Coding, annual coding updates for coding staff, practice staff and providers and leadership
Coordinates audits and corrective actions as needed related to billing practices.
Conducts internal audits of documentation, coding, and billing accuracy.
Monitors compliance with CMS payer, and regulatory guidelines.
Prepare reports and recommendations for leadership as needed.
Supports external audits and payer reviews.
Track key revenue cycle metrics and KPIs
Presents findings and strategic recommendations to senior leadership.
Other duties as assigned.