Senior Billing & Coding Compliance Program Manager

Responsible for leading, implementing, and monitoring billing and coding compliance plans/projects, and analyzing coding quality and accuracy.

Serve as coding compliance subject matter expert and develop education and training.

Collaborate with stakeholders to support Kroger Health billing/coding activities.

Demonstrate the company's core values of respect, honesty, integrity, diversity, inclusion, and safety.

Minimum
- High School Diploma or GED
- 5+ years coding auditing and medical coding experience
- AAPC/AHIMA certification
- Thorough knowledge of Medicare reimbursement guidelines and medical terminology
- Demonstrated coaching and influencing skills
- Knowledge/understanding of healthcare compliance industry and federal laws/regulations
- Attention to detail and ability to maintain a high degree of confidentiality
- Excellent presentation, verbal, and written communication skills
- Ability to identify opportunities for process improvement and implement solutions
- Highly self-motivated with ability to work independently and with a team, prioritize, and handle multiple responsibilities to meet deadlines
- Strong analytical, organizational, computer, and excel skills

Desired
- Bachelor's Degree
- Any compliance experience- Lead education, policy, and resource development/maintenance, and provide training support for coders, accounts receivable, practitioners, dietitians and clinic/pharmacy associates
- Research guidelines/regulations such as Medicare transmittals/Manuals, LCDs, NCDs and CMS/OIG guidelines pertinent to assessments
- Adhere to AAPC and/or AHIMA ethical coding standards, and remain abreast of changes to coding standards/regulations
- Serve as a Kroger Health resource to improve coding and documentation processes both internally and externally
- Responsible for coding/documentation reviews and audits to assess compliance and accuracy with ICD-10/CPT/HCPCS codes, modifiers, updated coding standards, and other regulatory guidelines/requirements
- Evaluate quality of clinical documentation to assess quality of data being submitted and/or reported, chart review trends, and audit findings
- Identify and communicate emerging issues and trends to stakeholders
- Coordinate external coding compliance audits, including sample selection, communications with external auditor and internal stakeholders, reviewing/analyzing audit results, and coordinating audit completion and follow-up
- Manage follow-up activities related to audits/reviews, ensure corrective action/remediation occurs (including internal follow-up audits), and prepare audit reports
- Liaison with coding vendors and internal coders
- Evaluate processes within area of responsibility to recommend and participate in process improvement initiatives
- Direct investigation of escalated coding, billing, and documentation compliance matters
- Perform or assist with assigned projects as required to maintain workflow and to meet schedules and quality requirements
- Participate in vari...