RCM CPC Manager

Advantia Health•Arlington, VA

14d•Remote

About The Position

The CPC Manager position will oversee all professional billing functions for Advantia Health. Professional billing functions include professional coding and timely claim submission, claim edits, insurance follow-up, and insurance denial management. The position collaborates with other Revenue Cycle leaders to provide feedback and guidance to providers and department leadership. This is a remote position that may require in-office attendance for monthly or quarterly meetings.

Requirements

2+ years of Athena experience and or super user
10+ years' experience in certified professional coding
Strong knowledge of ICD10 and CPT coding
In-depth working knowledge of all payer rules and policies
Effective Communication, presentation and project management
Excellent oral and written communication
Proficient experience in computer technology, including Microsoft word, PowerPoint and Excel.
Strong Training and evaluative skills
COVID-19 and Flu vaccination or an approved request for accommodation is required as a condition of employment.

Responsibilities

Facilitate accurate input of charge information including CPT, ICD-10, and HCPCS codes as selected by faculty physicians.
Ensure data is transmitted to insurance carriers in a timely manner.
Review month end metrics reports.
Remain current on medical billing guidelines, charge coding requirements, and communicate updated information to the appropriate department of contacts.
Provide timely feedback to departments regarding any delays or unexpected variances to standard performance.
Work with the Auditing Trainer to provide ongoing training for proper physician documentation and coding to maximize overall reimbursement.
Provides feedback to providers on performance improvement opportunities; tracks and prioritizes projects to improve coding and documentation outcomes.
Maintains a comprehensive tracking and management tool for assigned physicians within Advantia Health provider network.
Identifies issues, and reports results timely to ensure that physicians remain in compliance.
Presents progress and results to leadership on a routine basis.
Assists with CMS Risk Adjustment Data Validation activities to ensure our external physicians and Alignment Healthcare is prepared for and will pass an audit.
Regularly updates all Risk Adjustment materials with clinical and/or official guideline changes.
Suggests, updates, and enhances clinical educational materials to assist in training physicians and clinical staff in Coding and Documentation including CMS Models, Clinician Chart Reviews, and Encounter Documentation.
Suggest customizations of coding and documentation for various audiences; Support Staff, Providers, Specialists, and Employees.
Stays current on industry coding, compliance and HCC issues.
Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; and participating in professional societies.
Perform other duties as assigned.