Quality Manager

Our Billing Co. is seeking a Quality Manager to join our team! The Quality Manager ensures that all revenue cycle activities related to physician practices adhere to applicable laws, regulations, and standards, including billing, coding, reimbursement processes, and payer-specific rules. This role focuses on overseeing the accuracy and compliance of revenue cycle operations within a physician group or practice, ensuring timely and accurate reimbursement while minimizing risk.

Essential Functions

• Ensures the physician practice’s revenue cycle processes (e.g., billing, coding, documentation) are compliant with federal, state, and payer-specific regulations.
• Stays updated on industry changes related to CMS (Centers for Medicare and Medicaid Services), HIPAA, and other payer-specific requirements.
• Monitors healthcare law and policy changes and ensure they are promptly reflected in the practice’s billing processes.
• Leads internal audits to assess billing, coding, and documentation accuracy.
• Audits staff performance to improve productivity and streamline workflows.
• Identifies areas of risk related to compliance and implement corrective actions to mitigate risks.
• Manages the response and resolution of any external audits or investigations related to revenue cycle compliance.
• Develops, implements, and maintains policies and procedures that support compliance within the physician revenue cycle.
• Reviews and updates policies and workflows in response to regulatory changes or audit findings.
• Works with training team to develop and maintain compliance education and training for the billing, coding, and clinical teams to ensure understanding of healthcare regulations and payer requirements.
• Monitors key performance indicators (KPIs) such as coding accuracy, denial rates, and reimbursement delays, and take corrective action as needed.
• Prepares regular compliance reports for senior management, highlighting areas of concern, audits, and recommended actions.
• Has knowledge of ICD-10, CPT, and HCPCS codes.
• Audits physician documentation to ensure it supports the codes selected and services billed.
• Recommends process changes or automation opportunities to improve billing and coding accuracy and compliance.
• Acts as staff resource and role model for ethical, professional conduct.
• Delegates duties and projects to appropriate staff, and monitors for accurate and prompt completion.
  
  

Minimum/Preferred Qualifications

Education

• A bachelor’s degree in healthcare administration, business administration, or related field is required.
• Certification in healthcare compliance (e.g., CHC - Certified in Healthcare Compliance), revenue cycle management, or medical coding is highly preferred.
  
  

Work Experience

• Three (3) to five (5) years in physician revenue cycle management, billing, or coding with a strong focus on compliance.
• Previous experience with audits, risk management, and health regulations.
  
  

Certifications

• Certified Professional Coder, Certified in Healthcare Compliance, or Certified Revenue Cycle Professional preferred.
  
  

Knowledge, Skills And Abilities

• Deep understanding of billing and coding systems (ICD-10, CPT, HCPCS)
• Knowledge of physician-specific regulations and healthcare compliance standards
• Understanding of payer policies
• Ability to identify coding errors and discrepancies in claims.
• Strong written and verbal communication skills for effective interaction with physicians and staff at all levels.
• Ability to assess situations and propose solutions to resolve compliance issues. Organized and have a thorough understanding of Microsoft Office and Excel.
  
  

This is a fully remote position.

Our Billing Co. offers a competitive benefits package!

Pay Range: $80,000 - $110,000

Individual annual salaries/hourly rates will be set within job's compensation range, and will be determined by considering factors including, but not limited to market data, education, experience, qualifications, and expertise of the individual and internal equity considerations.

JOB CODE: 1000080