[Hiring] Manager of Coding & Revenue Integrity @Spire Orthopedic Partners

Role Description

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

• 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 timely coding of completed charts.
• Establish back up plan/cross coverage (to address time off, unexpected team absences, etc.) to ensure 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.

Qualifications

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

Benefits

• Excellent growth and advancement opportunities.
• Dynamic environment.
• Access to a diverse network of practitioners.
• Broad infrastructure of tools and programs to enhance the employee experience.
• Competitive Compensation.
• Generous PTO.
• Benefits package: health, dental, vision, 401(k), etc.