Manager, Coding & Billing Integrity

Description: • Perform chart reviews to ensure proper ICD-10, CPT, and HCC coding across professional services. • Educate providers on documentation standards for E/M leveling, time-based billing, and HCC coding. • Partner with clinical leadership to improve diagnosis specificity and close coding gaps. • Ensure alignment between clinical documentation, coding, and claim submission. • Monitor modifier usage, place-of-service accuracy, and billing edits to reduce denials. • Review pre-bill and post-bill data to catch errors before claims are submitted. • Collaborate with the billing team to respond to coding-related denials and payer inquiries. • Conduct internal audits to measure documentation quality, coding accuracy, and billing compliance. • Prepare reporting for leadership on trends, risk areas, and financial impact. • Stay current on CMS guidelines, payer policies, and code set changes; update internal teams accordingly. • Work closely with the VP of Revenue Cycle, compliance team, providers, and external coders. • Create and lead training sessions and materials for clinical and billing staff. • Support risk adjustment and value-based care initiatives with coding expertise and documentation insight. Requirements: • Bachelor’s degree in Health Information Management, Healthcare Administration, or related field preferred • CPC (Certified Professional Coder) mandatory • One or more of: CRC, CPMA, CCS-P, RHIT, or RHIA • 5+ years of experience in medical coding, documentation review, and billing compliance—focused on primary care services and nursing homes • 3+ years in a senior-level coding or billing position (lead or supervisory role preferred) • Strong knowledge of risk adjustment (HCC/RAF) and E/M coding • Strong interpersonal and communication skills, with a proven ability to foster cross-departmental collaboration. Benefits: • 401k with employer match • Comprehensive health, dental, and vision insurance • Paid time off (PTO) • Employer-paid life insurance policy Apply tot his job Apply To this Job