Manager Compliance Coding

Manager Compliance Coding

Work location:

Texas Health Resources

Core work hours:
Monday – Friday; 8:00 a‑5:00 p.

The Coding Compliance Manager oversees and manages auditing and monitoring activities related to billing and coding compliance. This role is responsible for developing policies, procedures, and risk‑based educational materials to ensure adherence to federal, state, and THR policies. Key responsibilities include analyzing audit data to identify areas of concern, collaborating with auditees, providers, and leadership to guide rebuttals, and establishing management correction plans when necessary.

The manager also effectively communicates audit findings through reports, presentations, and educational materials tailored for executive leadership and relevant stakeholders. Serving as a trusted resource, this position provides guidance to providers, HIMS, the Central Billing Office, and other departments regarding coding compliance, documentation standards, and applicable regulations.

• Work closely with various departments to align compliance practices with regulatory guidance and industry standards.
• Identify compliance risks, report findings, and recommend corrective actions to enhance regulatory compliance.
• Stay informed on evolving regulations and industry standards, ensuring the organization remains compliant and proactive.
• Support the Director in developing the annual work plan to strengthen compliance and audit effectiveness.
• Inform and educate the audit team, coding staff, and other relevant departments on regulatory requirements (CMS/Medicaid) and payer guidelines.
• Provide feedback on billing and documentation procedures, addressing conflicting or vague documentation issues.
• Conduct additional reviews to assist departments handling Medicare, OIG, or non‑Medicare denials.
• Research coding, documentation, and compliance inquiries from various departments, offering timely guidance based on federal, state, local, and THR policies.
• Lead the coding audit team, including training and performance evaluation, to maintain high standards of efficiency and compliance.
• Monitor and manage vendor performance to ensure compliance with contractual obligations, addressing and escalating issues as needed.
• Conduct compliance audits, perform internal audit testing to ensure adherence to regulatory requirements and organizational policies.
• Assist the audit team with inpatient, outpatient, and provider coding assessments to ensure assigned codes are supported by proper documentation.
• Perform second‑level reviews of the organization’s billing performance, verifying compliance with legal policies and regulatory requirements.
• Prepare detailed audit reports and present findings to senior leadership, Texas Health management, and relevant committees.
• Conduct follow‑up audits when findings indicate significant compliance risks, ensuring corrective actions are effectively implemented.

• Bachelor's Degree Required

• 6 Years in conducting compliance coding and billing audits including supervising and managing coding/auditing in a medium to large healthcare system. Must include supervisory and/or leadership experience.

• Experience partnering with providers on coding, documentation improvement, and audit findings is a plus.

• RHIT – Registered Health Information Technician
• RHIA – Registered Health Information Administrator
• CCS – Certified Coding Specialist
• CPC – Certified Professional Coder

• Strong understanding of leadership principles and best practices in team management, direction, and development.
• Expertise in planning, scheduling, and overseeing projects to drive operational efficiency.
• Exceptional oral and written communication skills to effectively convey complex regulatory and compliance concepts.
• Ability to analyze data, identify trends, and recommend solutions for complex compliance and coding challenges.
• Extensive knowledge of MS DRG, APC, ICD‑10‑CM/PCS, CPT, HCPCS coding, modifiers, NCCI edits, and official coding guidelines; strong understanding of medical terminology, human anatomy and physiology, pathophysiology, and pharmacology.
• E…