Program Integrity Investigator Jobs in Illinois (NOW HIRING)

Description:

 Job Title: Manager, Coding, Revenue Integrity and Provider Engagement

Job Description

Founded in 1991, IBJI is the largest orthopedic group practice in Illinois. With more than 150 physicians in every orthopedic specialty, IBJI offers care for adults and children from some of the most accomplished and respected orthopedists in the country. Serving northern Illinois and northwest Indiana with over 100 locations, IBJI makes it easy to access care. Our headquarters is in Park Ridge, Illinois, a northwest suburb of Chicago.

 

Our clinical services include advanced MRI imaging, pain management, non-surgical and surgical treatment plans, rheumatology, physical therapy, occupational therapy, wellness, and sports and sports training. Ortho Access walk-in clinics provide same day care for orthopedic injuries. Comprehensive care offered all in one place enables physicians, therapists and staff to work closely together, so that patients and families achieve better outcomes. Collaborative care is also more efficient. In many cases, IBJI services are substantially less expensive than those provided by large healthcare systems and emergency rooms.

Summary

The Manager, Coding, Revenue Integrity & Provider Engagement provides leadership and oversight for professional coding, coding-related revenue integrity, provider education, and physician revenue cycle support across Illinois Bone & Joint Institute (IBJI). This role establishes consistent coding standards, oversees outsourced coding services, monitors coding quality and performance, identifies revenue integrity opportunities, and ensures coding practices support accurate and compliant reimbursement. The Manager serves as a key connection between Revenue Cycle and IBJI physicians and advanced practice providers, translating coding, documentation, reimbursement, and revenue cycle trends into clear, actionable information. The position moves beyond individual account resolution to identify patterns, strengthen processes, develop education, and work collaboratively with providers, operational leaders, Revenue Cycle teams, Compliance, Information Technology, and external coding partners.

Responsibilities

• Provide overall leadership for professional coding operations, coding quality, coding standards, and coding related workflow across IBJI
• Establish and maintain standardized coding practices consistent with CPT, HCPCS, ICD-10-CM, CMS, NCCI, payer requirements, and applicable regulatory guidance
• Provide oversight of outsourced coding services, including service levels, turnaround times, quality, productivity, escalation processes, and contractual performance
• Partner with coding supervisors and external coding vendors to maintain appropriate coding workflow and timely charge submission
• Oversee coding work queues, coding edits, provider queries, charge corrections, and other coding-related exception processes
• Analyze coding related denials to identify trends, root causes, provider education opportunities, payer issues, system configuration concerns, and process gaps
• Partner with other Revenue Cycle leaders to ensure coding related denials are addressed consistently and appropriately
• Identify opportunities for appropriate revenue capture while maintaining compliant coding practices
• Evaluate trends involving modifiers, bundling edits, medical necessity, procedure coding, documentation, charge capture, and other areas affecting reimbursement
• Establish processes for reviewing potential under coding, over coding, missed charges, inappropriate edits, and other revenue integrity concerns
• Work with Epic and Revenue Cycle teams to identify system or workflow changes that can prevent recurring coding and charge capture issues
• Establish a structured coding quality program that includes routine audits, targeted reviews, trend analysis, and measurable quality expectations
• Partner with Compliance on coding concerns, regulatory interpretation, audit findings, and corrective action when appropriate
• Develop and maintain coding policies, procedures, reference materials, and standardized workflows
• Develop a structured provider education program focused on documentation, coding, reimbursement, medical necessity, and revenue cycle performance
• Develop provider tip sheets, educational materials, presentations, and specialty specific resources, and provide individual or group education based on identified trends and needs
• Coordinate coding and documentation education for new providers as part of the onboarding process and measure the effectiveness of provider education
• Serve as a primary Revenue Cycle resource for physicians and practice leadership regarding coding, documentation, reimbursement, and revenue cycle concerns
• Coordinate investigation and resolution of provider raised coding/coding denial concerns and identify when an individual concern represents a broader process, payer, or system issue
• Provide providers and leadership with meaningful performance information, including coding trends, denial patterns, documentation opportunities, and revenue cycle results
• Provide direct leadership, coaching, and development for assigned coding supervisors and other team members; establish clear expectations for quality, productivity, accountability, and issue escalation
• Lead and participate in cross functional process improvement efforts designed to reduce manual work, eliminate duplication, prevent denials, and improve revenue cycle performance
• Maintain a clean and safe work environment
• Other duties as assigned

Requirements:

Requirements

Education

• Bachelor's degree in healthcare administration, health information management, business, or a related field; equivalent relevant experience may be considered

Certifications/Licensure

• Professional coding certification such as CPC, CCS-P, CCS, or equivalent required

Experience

• Significant experience in professional coding, revenue cycle, revenue integrity, coding compliance, or a related healthcare field, including leadership responsibility
• Experience leading coding operations, coding quality, provider education, or revenue integrity functions; orthopedic/musculoskeletal coding, outsourced vendor management, Epic Resolute Professional Billing, and multispecialty physician enterprise experience strongly preferred

Technical Skills

• Advanced knowledge of CPT, HCPCS, ICD-10-CM, modifiers, NCCI edits, Medicare coding requirements, professional fee reimbursement, coding audits, denial analysis, and revenue integrity principles; proficiency with Epic Resolute Professional Billing and reporting tools preferred

Soft Skills

• Strong leadership, analytical, communication, organization, and change management skills with the ability to identify trends and move from individual account issues to broader operational solutions
• Demonstrated ability to build credibility and communicate effectively with physicians, advanced practice providers, operational leaders, executive leadership, Compliance, IT/Epic teams, and external partners

Physical Requirements

• Stand or sit for extended periods of time

This description is intended to provide only basic guidelines for meeting job requirements. Duties and responsibilities, experience, qualifications, skills, supervisory relationship, physical/mental demands, and environmental/ working conditions may change as needs evolve.

Base salary offers for this position may vary based on factors such as location, skills and relevant experience. We offer the following benefits to those who are benefit eligible (30+ hours a week):  medical, dental, vision, life and AD&D insurance, long and short term disability, 401k program with company match and profit sharing, wellness program, health savings accounts, flexible savings accounts, ID protection plan and accident, critical illness and hospital benefits. In addition, we offer paid holidays and paid time off.  

Illinois Bone and Joint Institute, LLC is an equal opportunity employer. All employment decisions are based on qualifications, merit, and business need, without regard to race, color, religion, age, sex, national origin, disability status, military or veteran status, sexual orientation, gender identity and expression, or any other characteristic protected by federal, state or local laws. This policy applies to recruitment and placement, promotion, training, transfer, retention, rate of pay and all other terms and conditions of employment.