Manager of Coding & Revenue Integrity

Who we are:

Spire Orthopedic Partners is a growing national partnership of orthopedic practices that provides the support capital and operational resources physicians need to grow thriving practices for the future. As a Management Services Organization (MSO) Spire provides the infrastructure for administrative operations that allows practices to operate at their highest level so doctors can focus their efforts on what matters most patient care. Headquartered in Stamford Connecticut the Spire network spans the Northeast with more than 165 physicians 1800 employees 285 other clinical providers and 40 locations in New York Connecticut Rhode Island and Massachusetts.

What youll do:

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

Responsibilities/Duties:

• 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.) toensure 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.

Who you are:

Qualifications:

• Bachelors 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.

What we offer:

• 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.

We are an equal-opportunity employer. Qualified Applicants are considered for positions and are evaluated without regard to actual or perceived race color creed religion national origin ancestry citizenship status age sex or gender (including pregnancy childbirth and related medical conditions) gender identity or gender expression (including transgender status) sexual orientation marital status military service and veteran status physical or mental disability protected medical condition as defined by applicable state or local law genetic information or any other characteristic protected by applicable federal state or local laws and ordinances (referred to as protected characteristics).