Assistant Manager, Coding QA - Emergency Medicine (ED)

• Ventra is a leading business solutions provider for facility-based physicians practicing anesthesia, emergency medicine, hospital medicine, and now radiology, through the recent combining of forces with Advocate RCM. Focused on Revenue Cycle Management and Advisory services, Ventra partners with private practices, hospitals, health systems, and ambulatory surgery centers to deliver transparent and data-driven solutions that solve the most complex revenue and reimbursement issues, enabling clinicians to focus on providing outstanding care to their patients and communities.

• As the Manager QA for Coding and Prebill, you will lead a team responsible for ensuring the accuracy and compliance of coding practices and prebill audits within the revenue cycle management process. Your primary focus will be on maintaining coding integrity, optimizing revenue capture, and minimizing compliance risks through rigorous quality assurance measures. You will collaborate closely with coding specialists, billing teams, and other stakeholders to drive continuous improvement and uphold the highest standards of quality in revenue cycle operations.

Quality Assurance Oversight:

• Develop and implement quality assurance strategies and protocols for coding and prebill processes to ensure compliance with regulatory requirements and industry standards.
• Establish key performance indicators (KPIs) and benchmarks to measure coding accuracy, completeness, and efficiency.

Coding Integrity:

• Lead a team of coding specialists responsible for assigning accurate diagnosis and procedure codes (ICD-10, CPT, HCPCS) based on medical documentation and coding guidelines.
• Conduct regular audits of coded encounters to verify compliance with coding conventions, documentation requirements, and payer guidelines.
• Provide feedback and coaching to coding staff to address performance gaps and promote continuous learning and improvement.

Prebill Audits:

• Oversee the prebill review process to ensure that claims are accurate, complete, and compliant with payer policies and contractual requirements before submission.
• Perform comprehensive audits of prebilled encounters to identify coding errors, documentation deficiencies, and potential compliance issues.
• Collaborate with billing teams to resolve audit findings and implement corrective actions to prevent claim denials and revenue loss.

Compliance and Regulatory Compliance:

• Stay abreast of updates to healthcare regulations, coding guidelines, and payer policies to ensure adherence to compliance requirements.
• Develop and maintain a strong understanding of coding and billing regulations, including HIPAA, CMS, and other regulatory frameworks.

Performance Analysis and Reporting:

• Analyze audit findings and performance metrics to identify trends, root causes, and opportunities for process improvement.
• Generate regular reports and presentations to communicate QA results, trends, and recommendations to senior management and stakeholders.

Training and Development:

• Provide training and educational resources to coding and billing staff on coding guidelines, documentation requirements, and compliance best practices.
• Foster a culture of accountability, quality, and continuous improvement within the coding and prebill audit team.

• Bachelor's degree in any related field.
• Certified Professional Coder (CPC) certification required; additional coding certifications (CCS, CPMA, etc.) preferred.
• Minimum of 8 years of experience in medical coding and auditing, with 3 years in a supervisory or managerial role.

• In-depth knowledge of ICD-10, CPT, HCPCS coding systems, and coding guidelines.
• Strong understanding of healthcare reimbursement methodologies, including Medicare, Medicaid, and commercial payers.
• Familiarity with electronic health record (EHR) systems and billing software applications (e.g., Epic, Cerner, Meditech).
• Excellent analytical skills with the ability to interpret complex coding and billing data.
• Exceptional communication and interpersonal skills, with the ability to collaborate effectively with multidisciplinary teams.
• Demonstrated leadership abilities, including the ability to mentor and develop staff, foster teamwork, and drive results.
• Detail-oriented mindset with a commitment to accuracy, integrity, and compliance.
• This position may require occasional travel for meetings, training sessions, or conferences.
• Flexible work hours may be necessary to accommodate project deadlines and business needs.

Equal Employment Opportunity (Applicable only in the US)
Ventra Health is an equal opportunity employer committed to fostering a culturally diverse organization. We strive for inclusiveness and a workplace where mutual respect is paramount. We encourage applications from a diverse pool of candidates, and all qualified applicants will receive consideration for employment without regard to race, color, ethnicity, religion, sex, age, national origin, disability, sexual orientation, gender identity and expression, or veteran status. We will provide reasonable accommodations to qualified individuals with disabilities, as needed, to assist them in performing essential job functions.
 
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Attention Candidates
Please be aware that there have been reports of individuals falsely claiming to represent Ventra Health or one of our affiliated entities Ventra Health Private Limited and Ventra Health Global Services. These scammers may attempt to conduct fake interviews, solicit personal information, and, in some cases, have sent fraudulent offer letters.
To protect yourself, verify any communication you receive by contacting us directly through our official channels. If you have any doubts, please contact us at Careers@VentraHealth.com to confirm the legitimacy of the offer and the person who contacted you. All legitimate roles are posted on https://ventrahealth.com/careers/.