Manager, Payer Clinical Services – HBA

This is a fully remote position, open to applicants in United States.

📋 Description

• Supervise hospital bill audits (HBA) for outpatient and facility reviews, ensuring accuracy and adherence to internal policies and industry standards.

• Detect gaps and opportunities for improvement while providing educational support to enhance audit quality and optimize revenue performance.

• Implement industry-standard coding guidelines, payer protocols, and pertinent audit-review references.

• Cultivate robust client relationships through meticulous clinical and coding audits, while addressing client concerns and requirements.

• Recognize trends in client denials and communicate findings to both the clinical team and clients.

• Manage training for existing staff and new hires regarding technology, regulatory updates, and operational procedures.

• Engage in the creation of educational resources for staff, ensuring clear communication of expectations.

• Guarantee that clients receive comprehensive historical and current trend reports, while sharing insights with clients, coding teams, and nursing teams.

• Mentor, coach, and develop clinical staff to enhance quality performance through servant leadership principles.

• Enhance management abilities to effectively lead teams and address operational challenges.

• Coordinate training for both new and current team members.

• Prepare, communicate, and assign client correspondences that support audit findings.

• Maintain necessary certifications and fulfill continuing education obligations.

• Execute additional responsibilities as needed.

• Assist in compliance requirements as requested by business partners.

⛳️ Requirements

• Preferred credentials include Registered Nurse certification.

• Active coding certification such as CCS, CPC, or CIC is required.

• Significant experience in overseeing hospital bill audits, itemized bill reviews, and high-dollar audits for both inpatient and outpatient facility claims.

• Proven experience in training others.

• Experience in leading or managing a team is essential.

• Comprehensive knowledge of CPT, HCPCs, ICD-10, and Revenue codes.

• Strong understanding of CMS and coding guidelines.

• Familiarity with inpatient and outpatient facility coding and billing regulations.

• Experience in policy development.

• Background in quality assurance is preferred.

• Experience with machine learning or artificial intelligence is a plus.

• Clinical Documentation Improvement experience is an advantage.

• Familiarity with Encoder, Codify, TruCode/TruBridge, 3M, WebStrat, or similar tools is beneficial.

• Ability to work predominantly in an indoor office setting, around computers and printers.

• Capability to perform sedentary tasks, including typing and repetitive computer-related motions throughout the day.

• Ability to focus on analytical tasks, read detailed information, and communicate effectively both verbally and in writing throughout the day.

• May be required to undergo background and drug screenings and disclose personal health information or identifiable information.

🏝️ Benefits

• Competitive salaries.

• Health insurance coverage.

• 401(k) plan with employer matching.

• Paid parental leave.