Healthcare Revenue Cycle Manager - Clinical Coding - 10916

The mission of the Colorado Coalition for the Homeless is to work collaboratively toward the prevention of homelessness and the creation of lasting solutions for homeless and at-risk families, children, and individuals throughout Colorado. The Coalition advocates for and provides a continuum of housing and a variety of services to improve the health, well-being, and stability of those it serves. Our Philosophy of Service: We believe all people have the right to adequate housing and health care. We work to remove the barriers that restrict access to these rights. Society benefits when adequate housing and health care are available to everyone. We create lasting solutions to homelessness by: ·         Honoring the inherent dignity of those we serve, affirming their capabilities and fostering their hope that a better life is possible. ·         Building strong, caring and trauma-informed communities through the integration of housing, health care and supportive services. ·         Advocating for social and racial equity, inclusion and diversity, and challenging the status quo in partnership with our workforce members and those we serve. ·         Achieving excellence through continuous quality assurance, innovation and professional development. ·         Using resources judiciously and effectively. NOTE: In order to ensure that our consumers receive the best possible care the candidate chosen to fill this position will be required to complete our internal credentialing and privileging process prior to a start date.  The credentialing and privileging timeline is dependent on the selected candidate's submission of documents necessary for clearance.  Please note that a start date will be scheduled once credentialing and privileging is complete. Employee must be able to perform essential job functions with or without reasonable accommodation and without posing a direct threat to safety or health of self or others. To perform this job successfully, an individual must be able to perform each essential function satisfactorily. Employee will perform job according to applied laws. The requirements listed above are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The Colorado Coalition for the Homeless is committed to delivering services, making employment-related decisions, selecting volunteers, and selecting vendors without regard to age over 40, race, sex, color, religion, creed, national origin, ancestry, disability, genetic information, marital status, sexual orientation, gender identity, gender expression, pregnancy, medical condition related to pregnancy, military status, or any other applicable status protected by law. Additional Requirement Valid driver’s license required. This requirement may be waived, if necessary, based on overall candidate experience and current needs of the business. Coalition Benefits Choice of HMO or PPO health insurance coverage options: full-time employees contribute only 1% of their earnings for their own HMO health coverage and no more than 4% of their earnings for coverage of eligible dependents. We’re proud to offer same-and opposite-sex domestic partner coverage. Choice of dental insurance or discount plan. Vision insurance. Flexible spending accounts for health care / dependent care / parking expenses. Free basic life and AD&D insurance coverage. Employee Assistance Program , a problem-solving resource available to you and your household members. Dollar-for-dollar retirement plan matching contributions up to 5% of earnings with 3-year vesting. Extensive paid time-off, including 9 holidays, 12 days of sick leave, and three weeks of vacation for new full-time employees in their first year. The effective date for your benefits will be the first of the month following your date of hire. Essential Job Functions Directs and supervises the clinical coding team (currently four coders with specializations in medical, behavioral health, and dental/vision), including hiring, onboarding, performance management, and professional development. Maintains a personal coding caseload across assigned specialization areas, ensuring hands-on proficiency with current coding guidelines, documentation requirements, and NextGen workflows. Establishes and manages ongoing communication with physicians, prescribers, behavioral health providers, dentists, and front-end revenue cycle staff to identify and resolve coding and documentation concerns; provides guidance and timely responses to coding and documentation questions. Leads clinical documentation improvement (CDI) initiatives, including provider education on documentation requirements within NextGen EHR, development of quick-reference guides, and ongoing compliance training. Collaborates with the Director and EHR team to identify opportunities for improving coding accuracy and efficiency through NextGen system configuration, template optimization, and workflow enhancements; provides coding-side requirements and feedback to inform EHR build and updates. Manages and maintains claim edit logic (scrubbers, code edits, payer-specific rules) within NextGen EPM, including effective use of the Background Business Processor (BBP), to prevent dirty claims and reduce front-end denials; coordinates with the EHR team and billing operations to ensure edits are current and aligned with payer requirements. Maintains a structured, ongoing feedback loop with the Billing Manager to identify denial root causes attributable to coding, documentation, or charge capture issues; implements upstream corrective actions to prevent recurring back-end denials Provides analysis and context for monthly revenue cycle performance KPIs, including claim projections, front-end denial rates, coding accuracy metrics, and charge capture trends. Maintains and communicates an expectations and trend report for review with the Director, identifying front-end denial patterns, coding concerns, and revenue optimization opportunities. Develops, implements, and conducts quarterly reviews of coding processes, workflows, and compliance protocols; ensures alignment with current federal and state regulations, FQHC billing requirements, and payer-specific guidelines. Conducts quarterly audits of the front-end coding team to verify adherence to established processes, ICD-10-CM/PCS, CPT, HCPCS, and CDT coding standards, and compliance regulations. Monitors regulatory changes affecting coding practices and ensures timely communication and implementation of required updates. Supports and trains the coding team in NextGen EPM workflows, coding issue resolution, and FQHC-specific billing nuances including PPS/wrap payments and sliding fee scale implications. Assists in identifying and tracking revenue cycle opportunities that may have a financial impact on the organization, including undercoding, missed charges, and payer-specific optimization. Performs other duties as assigned. Qualifications Summary Education and Work Experience Bachelor’s degree in health information management, healthcare administration, or related field; or five (5) years of equivalent professional experience. Minimum three to five (3–5) years of progressive experience in medical coding and revenue cycle management in a multi-specialty healthcare setting; FQHC or community health experience strongly preferred. CPC (Certified Professional Coder) certification required. CPMA (Certified Professional Medical Auditor) certification required within the first year of employment. Knowledge, Skills, and Abilities Expert knowledge of ICD-10-CM/PCS, CPT, HCPCS, and CDT coding systems and guidelines. Strong understanding of healthcare billing, finance, and accounting principles, including FQHC reimbursement methodologies (PPS, wrap payments, UDS reporting). Proficiency in NextGen EPM and EHR systems. Demonstrated ability to manage, coach, and develop a team of coding professionals. Knowledge of federal and state healthcare regulations, Medicare/Medicaid billing rules, and compliance frameworks.

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{
  "lists": [
    {
      "text": "Additional Requirement",
      "content": "<li><b>Valid driver’s license required. This requirement may be waived, if necessary, based on overall candidate experience and current needs of the business.</b></li>"
    },
    {
      "text": "Coalition Benefits ",
      "content": "\n<li>Choice of HMO or PPO health insurance coverage options: full-time employees contribute only 1% of their earnings for their own HMO health coverage and no more than 4% of their earnings for coverage of eligible dependents. We’re proud to offer same-and opposite-sex domestic partner coverage.&nbsp;</li>\n<li>Choice of dental insurance or discount plan.&nbsp;</li>\n<li>Vision insurance.&nbsp;&nbsp;</li>\n<li>Flexible spending accounts for health care / dependent care / parking expenses.&nbsp;</li>\n<li>Free basic life and AD&amp;D insurance coverage.&nbsp;</li>\n<li>Employee Assistance Program<strong>, </strong>a problem-solving resource available to you and your household members.&nbsp;</li>\n<li>Dollar-for-dollar retirement plan matching contributions up to 5% of earnings with 3-year vesting.&nbsp;</li>\n<li>Extensive paid time-off, including 9 holidays, 12 days of sick leave, and three weeks of vacation for new full-time employees in their first year.&nbsp;</li>\n\n<div>&nbsp;</div>\n<div>The effective date for your benefits will be the first of the month following your date of hire.</div>"
    },
    {
      "text": "Essential Job Functions ",
      "content": "\n<li>Directs and supervises the clinical coding team (currently four coders with specializations in medical, behavioral health, and dental/vision), including hiring, onboarding, performance management, and professional development.</li>\n<li>Maintains a personal coding caseload across assigned specialization areas, ensuring hands-on proficiency with current coding guidelines, documentation requirements, and NextGen workflows.</li>\n<li>Establishes and manages ongoing communication with physicians, prescribers, behavioral health providers, dentists, and front-end revenue cycle staff to identify and resolve coding and documentation concerns; provides guidance and timely responses to coding and documentation questions.</li>\n<li>Leads clinical documentation improvement (CDI) initiatives, including provider education on documentation requirements within NextGen EHR, development of quick-reference guides, and ongoing compliance training.</li>\n<li>Collaborates with the Director and EHR team to identify opportunities for improving coding accuracy and efficiency through NextGen system configuration, template optimization, and workflow enhancements; provides coding-side requirements and feedback to inform EHR build and updates.</li>\n<li>Manages and maintains claim edit logic (scrubbers, code edits, payer-specific rules) within NextGen EPM, including effective use of the Background Business Processor (BBP), to prevent dirty claims and reduce front-end denials; coordinates with the EHR team and billing operations to ensure edits are current and aligned with payer requirements.</li>\n<li>Maintains a structured, ongoing feedback loop with the Billing Manager to identify denial root causes attributable to coding, documentation, or charge capture issues; implements upstream corrective actions to prevent recurring back-end denials</li>\n<li>Provides analysis and context for monthly revenue cycle performance KPIs, including claim projections, front-end denial rates, coding accuracy metrics, and charge capture trends.</li>\n<li>Maintains and communicates an expectations and trend report for review with the Director, identifying front-end denial patterns, coding concerns, and revenue optimization opportunities.</li>\n<li>Develops, implements, and conducts quarterly reviews of coding processes, workflows, and compliance protocols; ensures alignment with current federal and state regulations, FQHC billing requirements, and payer-specific guidelines.</li>\n<li>Conducts quarterly audits of the front-end coding team to verify adherence to established processes, ICD-10-CM/PCS, CPT, HCPCS, and CDT coding standards, and compliance regulations.</li>\n<li>Monitors regulatory changes affecting coding practices and ensures timely communication and implementation of required updates.</li>\n<li>Supports and trains the coding team in NextGen EPM workflows, coding issue resolution, and FQHC-specific billing nuances including PPS/wrap payments and sliding fee scale implications.</li>\n<li>Assists in identifying and tracking revenue cycle opportunities that may have a financial impact on the organization, including undercoding, missed charges, and payer-specific optimization.</li>\n<li>Performs other duties as assigned.</li>\n"
    },
    {
      "text": "Qualifications Summary ",
      "content": "\n<li>Education and Work Experience</li>\n<li>Bachelor’s degree in health information management, healthcare administration, or related field; or five (5) years of equivalent professional experience.</li>\n<li>Minimum three to five (3–5) years of progressive experience in medical coding and revenue cycle management in a multi-specialty healthcare setting; FQHC or community health experience strongly preferred.</li>\n<li>CPC (Certified Professional Coder) certification required. CPMA (Certified Professional Medical Auditor) certification required within the first year of employment.</li>\n<li>Knowledge, Skills, and Abilities</li>\n<li>Expert knowledge of ICD-10-CM/PCS, CPT, HCPCS, and CDT coding systems and guidelines.</li>\n<li>Strong understanding of healthcare billing, finance, and accounting principles, including FQHC reimbursement methodologies (PPS, wrap payments, UDS reporting).</li>\n<li>Proficiency in NextGen EPM and EHR systems.</li>\n<li>Demonstrated ability to manage, coach, and develop a team of coding professionals.</li>\n<li>Knowledge of federal and state healthcare regulations, Medicare/Medicaid billing rules, and compliance frameworks.<br><br></li>\n"
    }
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