Coding Intelligence Program Manager

Summary

Join Included Health as a Coding Intelligence Program Manager and drive our billing and coding compliance initiatives. Reporting to the Senior Director, Revenue Cycle Management, you will leverage your deep understanding of healthcare administration, billing, coding, and compliance regulations. This individual contributor role requires ensuring compliant new service line development, addressing coding and billing needs, and collaborating with internal partners. You will conduct reviews, stay updated on regulatory changes, provide staff training, and analyze data to identify trends and risks. You will also prepare reports for senior management and regulatory authorities. The role offers a competitive salary and benefits package.

Requirements

• Minimum of 10 years of experience in healthcare billing, coding, and compliance, with at least 5 years in a leadership or management role
• Bachelor's degree in healthcare administration, business administration, or related field or equal years of field experience
• Certified Professional Coder (CPC) certification required
• Expert knowledge of healthcare billing and coding regulations, including Medicare, Medicaid, and private insurance guidelines
• Ability to interpret complex regulatory requirements and billing/coding data
• Experience managing complex compliance programs
• Prompt and regular attendance at assigned work location
• Capability to remain seated in a stationary position for prolonged periods
• Eye-hand coordination and manual dexterity to operate keyboard, computer and other office-related equipment
• No heavy lifting is expected, though occasional exertion of about 20 lbs of force (e.g., lifting a computer / laptop) may be required
• Capability to work with leadership, employees, and members in an appropriate manner

Responsibilities

• Develop, implement, and manage the coding intelligence program, ensuring compliance with all relevant laws, regulations, and guidelines
• Collaborate with the Go-To-Market and Client Services teams to integrate compliance considerations into new service line development including athena/EMR solutioning
• Conduct reviews and solution exercises on new coding needs and billing requirements, ensuring we meet compliance standards
• Stay updated on changes in healthcare regulations and billing/coding guidelines to proactively update policies and procedures
• Provide education and training to internal staff around billing and coding compliance requirements and best practices
• Act as the primary contact for all coding compliance-related inquiries and issues
• Analyze billing and coding data to identify trends, opportunities for improvement, and potential risks
• Prepare and present comprehensive reports on billing and coding compliance activities to senior management and regulatory authorities

Preferred Qualifications

Certified Coding Specialist (CCS) certification preferred

Benefits

• Remote-first culture
• 401(k) savings plan through Fidelity
• Comprehensive medical, vision, and dental coverage through multiple medical plan options (including disability insurance)
• Paid Time Off ("PTO") and Discretionary Time Off (“DTO”)
• 12 weeks of 100% Paid Parental leave
• Family Building & Compassionate Leave: Fertility coverage, $25,000 for surrogacy/adoption, and paid leave for failed treatments, adoption or pregnancies
• Work-From-Home reimbursement to support team collaboration home office work