Director, Medical Coding And Billing

Summary

Join Pomelo Care, a dynamic healthcare technology company, as their Medical Coding and Billing Director. You will lead a team, streamline processes, ensure compliance with coding regulations, and collaborate with various teams. This role requires 7+ years of revenue cycle experience and in-depth knowledge of CPT and ICD-10 coding. Preferred qualifications include 5+ years of medical coding experience and CPC certification. Pomelo offers a competitive salary, equity, benefits, and the opportunity to make a significant impact on maternal and child health.

Requirements

• 7+ years revenue cycle experience
• In-depth knowledge of CPT and ICD-10 coding guidelines and Medicaid coding rules
• Meticulous attention to detail
• Passionate about maternal and child health

Responsibilities

• Lead a team of medical coding and billing managers and specialists
• Streamline all internal processes and infrastructure for encounter coding and billing as we rapidly scale
• Collaborate with coding and billing team managers to build out trainings to support improved documentation for clinicians
• Stay up to date with coding regulations, guidelines, and changes in Medicaid rules, ensuring compliance with coding requirements
• Collaborate with our partnerships and customer success teams, as well as our health plan partners, on researching state-specific coding or billing related questions prior to health plan launches
• Track and report on billing and coding team KPIs, including team productivity, clean claims rate, outstanding A/R, denial rates, etc
• Identify and implement process improvements to enhance efficiency and effectiveness in revenue cycle operations and maximize value generation for the business
• Conduct regular audits to ensure accuracy of billing practices and no revenue or reporting leakage
• Work closely with Finance team on revenue reporting and reconciliation

Preferred Qualifications

• 5+ years medical coding experience
• Certified Professional Coder (CPC) certification or equivalent coding certification
• Experience coding for telehealth companies (including asynchronous encounters)
• Experience with the athenahealth EHR
• Expertise in coding for obstetrics/gynecology and pediatrics

Benefits

• Equity
• Benefits
• Other opportunities at Pomelo Care
• Salary range is $150,000-$180,000