RCM CPC Manager

The CPC Manager position will oversee all professional billing functions for Advantia Health. Professional billing functions include professional coding and timely claim submission, claim edits, insurance follow-up, and insurance denial management. The position collaborates with other Revenue Cycle leaders to provide feedback and guidance to providers and department leadership. 

This is a remote position that may require in-office attendance for monthly or quarterly meetings.


Job Responsibilities:

• Facilitate accurate input of charge information including CPT, ICD-10, and HCPCS codes as selected by faculty physicians.
• Ensure data is transmitted to insurance carriers in a timely manner.
• Review month end metrics reports.
• Remain current on medical billing guidelines, charge coding requirements, and communicate updated information to the appropriate department of contacts.
• Provide timely feedback to departments regarding any delays or unexpected variances to standard performance.
• Work with the Auditing Trainer to provide ongoing training for proper physician documentation and coding to maximize overall reimbursement.
• Provides feedback to providers on performance improvement opportunities; tracks and prioritizes projects to improve coding and documentation outcomes.
• Maintains a comprehensive tracking and management tool for assigned physicians within Advantia Health provider network.
• Identifies issues, and reports results timely to ensure that physicians remain in compliance.
• Presents progress and results to leadership on a routine basis.
• Assists with CMS Risk Adjustment Data Validation activities to ensure our external physicians and Alignment Healthcare is prepared for and will pass an audit.
• Regularly updates all Risk Adjustment materials with clinical and/or official guideline changes.
• Suggests, updates, and enhances clinical educational materials to assist in training physicians and clinical staff in Coding and Documentation including CMS Models, Clinician Chart Reviews, and Encounter Documentation.
• Suggest customizations of coding and documentation for various audiences; Support Staff, Providers, Specialists, and Employees.
• Stays current on industry coding, compliance and HCC issues.
• Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; and participating in professional societies.
• Perform other duties as assigned.

Job Requirements:

• 2+ years of Athena experience and or super user
• 10+ years' experience in certified professional coding
• Strong knowledge of ICD10 and CPT coding
• In-depth working knowledge of all payer rules and policies
• Effective Communication, presentation and project management
• Excellent oral and written communication
• Proficient experience in computer technology, including Microsoft word, PowerPoint and Excel.
• Strong Training and evaluative skills

Please note: Advantia Health provides unparalleled healthcare to our customers by employing the most highly qualified individuals. If you are selected for further consideration, you will be subject to a background investigation. COVID-19 and Flu vaccination or an approved request for accommodation is required as a condition of employment.

Advantia Health is an Equal Opportunity Employer that is committed to global diversity: It is a place where good people want to work, and customers want to continue to engage EOE M/F/D/V.