Coding & Revenue Integrity Manager
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Job Description
Coding & Revenue Integrity Manager role at ReKlame Health focusing on revenue protection in Medicaid and managed-care environments. Involves strategic coding and compliance oversight.
Responsibilities:
- Own CPT/ICD-10 coding and strategy across psychiatry and medication management, with a focus on high-acuity and complex patient populations.
- Improve first-pass claim acceptance by proactively ensuring correct coding.
- Develop payer-specific playbooks aligned with the fee schedule provided by our partners.
- Lead pre-bill and post-pay audits on a rolling basis.
- Identify denial, reversal, and clawback patterns through EOB analysis and flag systemic risks to improve the process.
- Translate insights into workflow and system improvements, working closely with Clinical Leadership, team members, tools, and technology.
- Ensure compliance and alignment with CMS, state Medicaid, and managed-care guidelines.
- Partner with Finance and Business Operations to identify, evaluate, and implement best-in-market billing technologies and automation solutions to improve efficiency.
Requirements:
- Certifications: Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent certification in medical coding is mandatory.
- Technical Skills: Advanced proficiency with ICD-10, CPT, and HCPCS coding systems and experience with EHR and medical billing software.
- Experience: Minimum of 5-10 years of professional experience in medical coding and billing, including expertise with Medicare and Medicaid systems.
- Strong preference for candidates with experience in behavioral health coding.
- Leadership Skills: Demonstrated experience leading and mentoring a team, with a history of improving performance and operational workflows.
- Detail-Oriented: Exceptional accuracy and attention to detail in coding/billing and documentation.
- Regulatory Knowledge: Strong understanding of HIPAA and healthcare compliance guidelines, with the ability to adapt to changing regulations.
- Problem-Solving Expertise: Analytical mindset with the ability to address complex challenges, identify solutions, and implement improvements with speed and accuracy.
- Must be comfortable with EOBs, patterns, and payer behavior.
Benefits:
- Full Health Benefits: Medical, dental, and vision
- Paid Time Off (PTO): 21 days of paid time off, including vacation and sick leave.
- Professional Development: Unlock growth opportunities within a purpose-driven early-stage organization dedicated to creating a positive impact.
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