Coding and Contracts Compliance Manager

Operations

Camas, WA

Job Summary

Serving as a subject matter expert within Fuel Medical Group, the Medical Coding Compliance Manager, will act as a resource to ENT Physicians, Audiologists, Practice Managers, and Fuel staff in the field of Otolaryngology, Audiology, Allergy billing, coding, insurance contracts, and Medicare and Medicaid regulations.

Using their knowledge of CMS and insurance contracts in an Ear, Nose and Throat Practice with Audiology and Allergy as major departments, the Manager will train on various topics that will include using medical coding and classification systems to calculate and invoice patients. They also submit procedure and diagnosis claims to insurance companies for reimbursement.

Key Responsibilities

  • Able to analyze procedures and contracts and provide recommendations to maximize services and resolve issues.
  • Able to analyze superbills and related documentation and makes appropriate recommendations to ensure revenues are maximized and legality is maintained, and trains on best practices in this area.
  • Uses knowledge of current ICD-10-CM and CPT codes to create lists of relevant codes and their purposes, and train Fuel staff and Members on their appropriateness in ENT and Audiology settings.
  • Able to read medical contracts and understand the implications of any carve-outs, and then makes recommendations for appropriate solutions to the issues these carve-outs may cause.
  • Works with Member practices and others to understand, maximize, train on CMS coding processes and procedures.
  • Understands implications of capitation and makes recommendations to maximize contracts for members.
  • Build and maintain strong relationships with internal and external key contacts to ensure proper communication of company beliefs and service offerings.
  • Work collaboratively with shared services teams to answer internal and external questions.
  • Complete other professional development duties and projects as assigned.

Requirements and Qualifications

  • Minimum of 5 years working in a Billing, Coding, Contracts compliance capacity in an Ear, Nose and Throat/Otolaryngology practice with Audiology and Allergy Departments required. Experience with Cochlear procedures and associated CPT codes a plus.
  • Bachelor’s degree preferred, but not required; Certificate from American Health Information Management Association or Associate‚Äôs degree in health information technology, a plus.
  • Thorough knowledge of Center for Medicare and Medicaid Services (CMS) procedures.
  • Thorough knowledge of medical and DME contracts and codes in an ENT and Audiology setting.
  • Thorough understanding of HIPAA requirements.
  • Experience with EMR, EHR and appointment scheduling software.
  • Experience training all levels of staff on proper procedures and related rationale.
  • Passion for helping others understand new information and training for improved performance.
  • Extremely strong attention to detail and organizational skills.
  • Excellent project management skills and the ability to work under tight deadlines.
  • Demonstrated success in working with multiple stakeholders.
  • Superior written and verbal communication skills.
  • Strong analytical skill set with the ability to work comfortably with Excel-based systems.
  • Ability to work independently and in a multi-disciplinary team environment by being adaptable and open-minded.
  • A history of operating with a sense of urgency with proven results.