Manager, Billing and Coding - Sleep Medicine - Ohio Sleep Medicine Institute

As Manager, Billing and Coding, you play a vital role in our mission to improve lives. Lead and oversee the professional and/or facility billing and revenue cycle operations for the sleep medicine practice. At Vituity we know the impact you can have.

At Vituity we’ve cultivated an environment where passion thrives, and success comes through shared purpose. We were founded in a culture that values team accomplishments more than individual achievements, an approach we call “culture of brilliance.” Together, we leverage our strengths and experiences to make a positive impact in our local communities. We foster this through shared goals and helping our colleagues succeed, and we also understand the importance of recognition, taking the time to show appreciation and gratitude for a job well done.

Vituity has opportunities at 900 practices across the country, serving 14.5+ million patients a year. With Vituity, if you ever need to move, you can take your job with you.

• Supervise, train, schedule, and develop billing team staff, establishing clear productivity and quality standards and providing ongoing coaching and feedback.
• Oversee the day-to-day billing and revenue cycle operations for the sleep medicine practice to ensure accurate and timely billing of professional and/or facility services.
• Establish, monitor, and report on key performance indicators (KPIs) for billing, coding, collections, and accounts receivable.
• Serve as the escalation point for complex billing issues, payer disputes, and patient billing inquiries.
• Develop, document, and maintain billing workflows, policies, and standard operating procedures to promote consistency and efficiency.
• Partner with the medical director, providers, and practice leadership to align billing operations with organizational goals.
• Review Accounts Receivable and Collection Write-Off Reports and approve appropriate action, including establishing payment plans or referring accounts to a collection agency.
• Oversee the review and analysis of medical records and documentation to ensure accurate coding and billing.
• Ensure appropriate assignment of ICD-10, CPT, and DRG codes for sleep studies (e.g., polysomnography, home sleep apnea testing, MSLT, MWT) and related services.
• Audit charges and coding for accuracy, completeness, and compliance, and provide education and feedback to staff and providers.
• Oversee verification of patient insurance coverage and completion of required prior authorizations for sleep medicine services.
• Ensure timely and accurate preparation and submission of claims to insurance companies for reimbursement.
• Perform and oversee pre-verifications with insurance companies to determine where to send the claim, via phone or by running online eligibility.
• Monitor payer policies, sleep medicine coverage criteria, and regulatory changes, and update billing processes accordingly.
• Oversee follow-up on unpaid or denied claims and the resolution of billing discrepancies to maximize reimbursement.
• Direct the application of medical collection practices and procedures in accordance with payer and regulatory requirements.
• Apply critical thinking to determine when a payer is in violation of contract terms or a legal obligation to pay, and pursue appropriate resolution.
• Ensure compliance with HIPAA, payer contracts, and organizational policies, and promptly report and address suspected compliance concerns.
• Maintain the confidentiality of patient information in accordance with HIPAA regulations and Privacy Policies regarding PHI.
• Prepare and present billing, collections, and revenue cycle performance reports to…