Coding Auditor Jobs in Raleigh, NC (NOW HIRING)

Join Avance Care - A Leading Force in Independent Primary Care!

Avance Care is a rapidly growing network of 35 primary care practices across the Triangle (Raleigh-Durham-Chapel Hill), Charlotte, and Wilmington, NC. We are committed to transforming healthcare by providing comprehensive services that support the physical, mental, and emotional well-being of our patients.

We are currently seeking an experienced Coding Manager to lead a team of Certified Professional Coders (CPCs) to generate the best possible financial outcome for the practices at the lowest possible compliance risk through primary care advocacy, research, collaboration, structured communication, and standardized processes.

Essential Duties and Responsibilities:

Operational:

• Ensure compliance to
  • Coding standards as defined by the AMA through CPT, ICD, and HCPCS
  • Government and Commercial Payer Contracts
  • Accountable Care Organization (ACO) agreements
  • CPT Category II quality reporting
• Hold and attend regular meetings with coders, billing staff, providers, managers, and other stakeholders to share information and communicate on company issues, as needed
• Interview, hire, and provide orientation to coding staff
• Reporting including, but not limited to:
  • Monthly status reports
  • Insurance fee schedules
  • Charge lag including claims awaiting provider completion and claims awaiting coding.
• Support Avance Care's strategic execution of ACO agreements, as they relate HCC/RAF, CPT Category II coding, and other coding deliverables.
• Compliance planning as it relates to government and private contracts, rules, and regulations, including execution of compliance policy and procedure at the coding level.

Claims Management:

• Execute all facets of the coding aspect of revenue cycle management.
• Ensure scalable but nimble coding structure that supports the organization's growth plan
• Supervise and train coding staff, both local and outsourced.
• Manage department workload and growth, including assignment of work and staffing plans
• Regularly review coding and documentation for accuracy and compliance.
• Supervise all coding employees in order to:
  • Safeguard adherence to Avance Care Policies and Procedures
  • Encourage employee behavior that represents the company in the best light
  • Ensure standardized processes are executed efficiently
• Oversee all claims production, including creation, submission, secondary claims, and charge lag.

Personnel Management:

• Resolve issues outside the billing department, such as providers, operators, or regulators
• Communicate effectively and politely with all staff members to minimize and eliminate employee dissatisfaction and conflicts
• Address employee complaints in a timely manner
• Interview, train, counsel, coach, discipline, and terminate employees, as necessary
• Manage employee scheduling, vacation requests, and continuous shift coverage
• Conduct staff meetings to share information and communicate on company issues
• Train new and existing providers, with assistance from coding team
• Review, revise (as necessary), and maintain Operating Procedures and Training Manuals
• Conduct bi-annual employee performance evaluations
• Notify the Vice President of RCM, Human Resources, and other managers of all non-routine matters relating to the operations and affairs of the areas for which the position is responsible, including but not limited to significant concern, current problems, and potential problems

Ideal candidates will have a bachelor's degree in business administration, health administration or related field required, but MHA, or MBA highly preferred. Along with 6-8 years of office-based coding experience. An active CPC Certification required (additional certifications such as CPME, CRC, CDEO preferred). Multispecialty, hospital, ambulatory, and/or surgical coding experience with knowledge of CPT, HCPCS, and ICD-10 coding desired.

Other Priorities:

• Proficiency at writing reports, business correspondence, and procedure manuals
• Ability to work with mathematical concepts such as probability and statistical inference and apply to concepts such as fractions, percentages, ratios, and proportions to practical solutions
• Skilled at defining problems, collecting data, establishing facts, and drawing valid conclusions
• Competent to make independent decisions and delegate responsibility and duties
• Proficient computer skills, including knowledge of EHR, Microsoft Office Suite, e-mail systems, and web-based programs
• Strong leadership qualities
• Knowledge and understanding of how for-profit medical practices run
• Working knowledge of accounting, including ledger, balance sheet, payroll, taxation, etc.

Why Join Avance Care?

Be part of a mission-driven organization that is changing the way healthcare is delivered across North Carolina. We offer a supportive, collaborative work environment where your leadership will make a measurable impact.

Avance Care provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to religion, race, creed, color, sex, sexual orientation, gender identification, alienage or citizenship status, national origin, age, marital status, pregnancy, disability, veteran or military status, predisposing genetic characteristics or any other characteristic protected by applicable federal, state or local law.