Position Summary / Scope of Responsibility

MedVanta is the nation's largest physician-owned and operated next generation management services organization (MSO). Our services are specifically designed for musculoskeletal (MSK) providers and go beyond that of a traditional MSO, empowering our clients with the precise infrastructure, data, technology, and administrative processes needed to thrive both today and tomorrow.

MedVanta has an employee centered culture that supports and promotes diversity and inclusion. Our encouraging and empowering management style makes MedVanta a great place to further grow your knowledge while building a team driven path to success.

The Billing and Coding Compliance Manager will ensure compliance in billing regulations, develop compliance billing policies and training, and establishes and maintains an efficient and timely coding, auditing, and education process while ensuring the accuracy and quality of coded and abstracted information for all patient types across physician services.

Primary Responsibilities

The incumbent may be asked to perform job-related tasks other than those specifically stated in this description. The duties and responsibilities of the position are to be carried out in a manner that is consistent with the Mission, Core Values and Operating Principles of MedVanta.

1. Audit Planning: Research applicable documentation and reimbursement regulations to apply in the development of an audit plan for both scheduled and unscheduled audits and investigations.

2. Conducting Audits: Performs documentation and coding audits, reviewing medical records and charges to ensure compliance with CPT coding standards and the Centers for Medicare & Medicaid Services (CMS) conditions of coverage and guidelines.

3. Analysis, Reporting, and Education: Conducts analysis of audit findings to identify trends/problems in billing and documentation. Writes reports explaining the audit process and present findings to leadership. Delivers education and training to providers on audit results and corrective action plans.

4. Investigations and Monitoring: Tracks and maintains monitoring program to identify potential billing and coding issues and conduct investigations as needed.

5. Compliance Program Activities: Participates in compliance program activities, such as assisting with policies and procedures related to billing and coding compliance, risk assessment and compliance workplan development, and presents progress updates to quarterly executive compliance committee meetings.

6. Maintains an appropriate professional appearance and demeanor in accordance with Company policies in all training and leadership communications with staff and client staff/physicians.

7. Provides regular operational reports and updates to direct supervisor to inform them of work progress, timetables, and issues as they arise.

8. Performs other duties as assigned.

Reporting Relationships

The Billing and Coding Compliance Manager reports directly to the Vice President of Revenue Cycle Management.This role does have direct reports.

Required Education and Experience

1. Bachelor’s Degree in relevant area of study required.

2. 3-5 years of experience working in revenue cycle in a health system, medical practice, or health plan required.

3. 1-2 years of medical compliance auditing experience required.

4. AHIMA Certified Coding Specialist (CCS) certification preferred.

5. Additional CPC, CPMA, and/or CHC certifications highly preferred.

6. Must display proven expert knowledge of CPT, ICD-10, and HCPCS coding.

7. Must be a demonstrated team leader with excellent experience communicating with effective interpersonal skills (oral and written) to maintain communication with management, co-workers, and physicians.

8. Ability to draw valid conclusions, apply sound judgement, and make decisions under pressure from multiple directions.

9. Experience drafting, interpreting, and applying both reactionary and proactive policies and procedures.

Competencies / Required Skills and Abilities

1. Proven success leading and inspiring teams through respectable actions, words, and deeds for teams, clients, management, and mission.

2. Ability to work in an ad-hoc and demanding environment with limited or vague information available at times.

3. Strong interpersonal, oral, and written communication skills with excellent self-discipline and patience.

4. Confident, independent thinker and strong decision-making ability when circumstances warrant such action.

5. Demonstrated ability to organize, prioritize, and manage multiple tasks in a dynamic environment with a proven track record of results.

6. Ability to develop relationships and collaborate in a decentralized organization. Able to work independently as well.

7. Exudes professionalism in presentation.

8. Must be able to read, write, speak, understand, and communicate in the English language.

Physical Demands

1. Must be able to sit for long periods of time and lift up to 25 pounds

2. Must be able to use appropriate body mechanics techniques when performing front desk duties.

3. Requires frequent bending, reaching, repetitive hand movements, standing, walking, squatting,

and sitting.

4. Adequate hearing to perform duties in person and over telephone.

5. Must be able to communicate clearly to patients in person and over the telephone.

6. Visual acuity adequate to perform job duties, including reading materials from printed sources

and computer screens.