Manager Coding Compliance; Hybrid - Emergency Medicine

Scheduled Hours

40

Provides operational and managerial leadership for coding compliance and charge capture activities supporting hospital-based and professional services. This position handles the day-to-day operations of charge capture activities, assuring regulatory compliance while maximizing appropriate revenue. Reporting within the revenue cycle/compliance structure, this role partners directly with faculty, coders and operational leaders, conducts audits and education, and serves as a liaison to institutional compliance functions.

The role exercises independent judgment within established policies and contributes to departmental performance, risk mitigation, and revenue integrity.

• Partners with Coding and Billing staff to ensure hospital-based services are captured timely, accurately, and compliantly to maximize appropriate revenue.
• Works directly with external coding vendors to ensure adherence to federal, state, payer, and organizational coding and billing compliance requirements.
• Serves as the primary compliance liaison with the coding vendor, overseeing audit findings, corrective actions, and ongoing compliance monitoring.
• Collaborates with the coding vendor to identify, address, and prevent compliance risks related to coding accuracy and regulatory standards.

• Performs compliance duties including medical record reviews, physician audits, and OPBC audits.
• Ensures OPBC and departmental compliance guidelines are consistently applied to billed services.
• Analyzes audit findings and charge capture trends; develops and implements corrective actions within the department’s authority.

• Directly interacts with clinical providers regarding coding, charge capture, compliance, and billing issues.
• Develops educational materials and conduct regular meetings with clinical providers to improve coding accuracy and documentation quality.
• Serves as a subject matter expert for complex coding and compliance questions within assigned scope.

• Ensures staff attendance at required training and in-services.
• Provides targeted education to coding staff and providers based on audit results, regulatory updates, and performance trends.
• Coaches staff on best practices and adherence to policies.

• Communicates billing policies and procedures to staff to promote efficient, compliant workflows.
• Maintains current knowledge of Medicare, Medicaid, HMO, PPO, and other payer requirements affecting operations.
• Recommends process improvements and participate in system or workflow enhancements.

• Serves as compliance liaison to the WU Office of Physician Billing Compliance.
• Collaborates with Revenue Cycle, Billing, Compliance, Clinical Operations, and IT to resolve issues and improve outcomes.
• Prepares routine operational and compliance reports for departmental leadership.
• Exercises independent judgment within established policies and procedures.
• Accountable for operational outcomes (timeliness, accuracy, compliance) within assigned services.
• Influences clinical providers and cross-functional partners.

• Serves as the primary operational liaison for the department’s third-party coding vendor as it relates to auditing, departmental workflows, compliance standards, and provider education.
• Reviews vendor work output, identifies trends or issues, and collaborates with vendor to implement corrective actions and process improvements.
• Coordinates vendor-supported audits, education, or supplemental coding services as needed to support departmental operations.
• Escalates performance, compliance, or operational concerns through appropriate leadership and governance channels.
• Partners with internal stakeholders to ensure vendor activities remain compliant with institutional policies and OPBC requirements.

• Normal office environment.

• Typically sitting at a desk or a table.

• Office equipment.