Senior Manager - Coding Audit and Compliance

Job DescriptionJob DescriptionDescription:

Panacea Healthcare Solutions, a leader in providing customized financial solutions to healthcare providers, is expanding its credentialed staff to perform coding audit, support, and review.

Panacea has a hybrid work environment and can support remote work.

We are seeking a skilled and experienced Auditor/Consultant with managerial experience to join our team. The ideal candidate will be responsible for assisting the Executive Director in overseeing and managing our audit team to ensure the accuracy, efficiency and compliance of all client engagements. This position requires a strong understanding of coding principles, healthcare regulations and industry best practices as well as exceptional leadership and communication skills.

Key Responsibilities

• Audit management: Plan, conduct, and oversee coding audits to assess the accuracy of coding and billing practices.
• Compliance oversight: Ensure compliance with all applicable coding guidelines, regulations, and internal policies (e.g., CMS guidelines, OIG regulations, and HIPAA).
• Team oversight: Provide day to day oversight of coding auditors, including assigning work, monitoring performance, and providing training and development opportunities.
• Education & Training: Develop and deliver coding education and training programs for coders, auditors, providers, and other relevant staff to address audit findings and promote best practices.
• Relationship Management: Build and maintain strong relationships with internal and external stakeholders, including revenue cycle teams, providers, clients, and regulatory bodies.
• Data Analysis & Reporting: Review and analyze audit data, identify trends, and generate reports for management and other stakeholders, communicating findings and recommendations effectively.
• Research & Consultation: Serve as a coding subject matter expert, conduct research on coding changes and issues, and provide guidance and recommendations to resolve complex coding-related problems.

Requirements:

• Education: Bachelor's degree in Health Information Management or a related field; or equivalent experience.
• Certifications: Possess a relevant coding credential such as Certified Coding Specialist (CCS), Certified Professional Coder (CPC), or Certified Professional Medical Auditor (CPMA).
• Experience: A minimum of 5 years of coding experience, with at least 2-3 years in a coding audit or management role is typically required. Experience across multiple specialties is often .
• Technical Knowledge: Deep understanding of ICD-10-CM, CPT, and HCPCS coding systems, including E/M coding, split/shared rules, and incident-to billing. Familiarity with relevant software like encoders, groupers, abstracting systems, and EHRs is beneficial.
• Regulatory Knowledge: Comprehensive understanding of federal and state coding regulations, including CMS guidelines, OIG Work Plan, and payer-specific rules.
• Analytical & Problem-Solving Skills: Ability to analyze complex data, identify coding issues and trends, and develop effective solutions.
• Communication & Interpersonal Skills: Excellent written, verbal, and presentation skills to effectively communicate with diverse stakeholders and deliver training, in person, by phone and in writing.
• Team Management: Demonstrated ability to lead, mentor, and motivate a team, manage workflows, and foster a collaborative environment.
• Organizational Skills: Strong organizational skills with meticulous attention to detail to ensure accuracy and compliance.