ReKlame Health · 18 hours ago
Coding & Revenue Integrity Manager
United States
Full-time
Remote
Mid, Senior Level
$80K/yr - $100K/yr
5+ years expReKlame Health is a clinician-led, tech-enabled provider group focused on expanding access to behavioral health and addiction care. The Coding & Revenue Integrity Manager will protect and optimize revenue in a complex Medicaid and managed-care environment by overseeing coding strategy, conducting audits, and ensuring compliance with healthcare guidelines.
Health Care
Responsibilities
Own CPT/ICD-10 coding and strategy across psychiatry and medication management, with a focus on high-acuity and complex patient populations
Improve first-pass claim acceptance by proactively ensuring correct coding
Own CPT/ICD-10 coding and strategy, with a focus on high-acuity and complex patient populations. Improve first-pass claim acceptance and minimize post-payment exposure to retroactive clawbacks and recoupments
Develop payer-specific playbooks aligned with the fee schedule provided by our partners. Create payer-specific guides that are consistent with the fee schedules provided by our partners
Partner with Clinical Ops to ensure documentation supports billed services
Lead pre-bill and post-pay audits on a rolling basis
Identify denial, reversal, and clawback patterns through EOB analysis and flag systemic risks to improve the process
Produce clear summaries of findings and recommendations
Translate insights into workflow and system improvements, working closely with Clinical Leadership, team members, tools, and technology (e.g., reducing variance in documentation quality across providers)
Establish training materials and feedback loops between providers and the administrative team, and escalation pathways for high-risk claims or payer disputes
Serve as the senior coding authority for billers, AR/recovery experts, specialists, and RCM vendors
Ensure compliance and alignment with CMS, state Medicaid, and managed-care guidelines
Monitor changes in payer policy and coding guidance
Partner with the Credentialing team on the implementation of new payor contracts
Partner with Finance and Business Operations to Identify, evaluate, and implement best-in-market billing technologies and automation solutions to improve efficiency, reduce manual effort, and scale operations in line with growing claim volume
Collaborate with finance and business Operations to pinpoint, assess, and deploy leading billing technologies and automation solutions. The goal is to enhance efficiency, minimize manual labor, and ensure operational scalability as claim volume increases
Continuously recognize and implement opportunities to accurately capture reimbursement for patient care and procedures
Qualification
Required
Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent certification in medical coding is mandatory
Advanced proficiency with ICD-10, CPT, and HCPCS coding systems and experience with EHR and medical billing software
Minimum of 5-10 years of professional experience in medical coding and billing, including expertise with Medicare and Medicaid systems
Proven track record in audits, compliance, and revenue protection/integrity
Demonstrated experience leading and mentoring a team, with a history of improving performance and operational workflows
Exceptional accuracy and attention to detail in coding/billing and documentation
Strong understanding of HIPAA and healthcare compliance guidelines, with the ability to adapt to changing regulations
Exceptional written and verbal communication abilities to effectively collaborate with stakeholders at all levels
Analytical mindset with the ability to address complex challenges, identify solutions, and implement improvements with speed and accuracy
Must be comfortable with EOBs, patterns, and payer behavior
Preferred
Strong preference for candidates with experience in behavioral health coding
Benefits
Full Health Benefits : Medical, dental, and vision
Paid Time Off (PTO) : 21 days of paid time off, including vacation and sick leave.
Professional Development : Unlock growth opportunities within a purpose-driven early-stage organization dedicated to creating a positive impact.
Company
ReKlame Health
A culturally-diverse telepsychiatry practice providing high-quality, affordable treatment to young & BIPOC individuals.
11-50 employees
Funding
Current Stage
Early StageLeadership Team
Evans Rochaste, NP
Founder|CEO
Recent News
2023-04-12
2023-03-10
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