Associate Director – Billing, Coding

🔥 0 minutes ago

🦌 Connecticut – Remote

🦌 Connecticut – Remote

💵 $113.2k - $169.8k / year

⏰ Full Time

🟠 Senior

📊 Billing Specialist

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Spire Orthopedic Partners

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2021

🤝 B2B

🏢 Enterprise

B2B • Enterprise

Spire Orthopedic Partners is a forward-looking capital and management partner for leading orthopedic and spine surgeons, operating as a management services organization (MSO) that provides administrative infrastructure and strategic support. The company partners with high-growth orthopedic practices across the Northeastern United States (Connecticut, New York, Massachusetts, Rhode Island), enabling around 165 physicians and 1,800 employees across 40 locations to grow, specialize, and focus on patient care while Spire handles operations, practice integration, and business development.

📋 Description

• Directly oversee professional coding operations. • Ensure accurate CPT, HCPCS, and ICD-10 coding in accordance with payer and regulatory guidelines. • Monitor coding productivity and quality on a daily and weekly basis. • Conduct routine internal audits and address coding variances promptly. • Lead corrective action plans when audit results fall below target thresholds. • Stay current with CMS, payer, and specialty-specific coding updates. • Oversee timely and accurate charge entry for all clinical services. • Monitor lag days from date of service to claim submission. • Identify and resolve missing charges, interface errors, and documentation gaps. • Implement controls to reduce unbilled inventory and prevent revenue leakage. • Validate modifiers and ensure compliance with payer-specific billing rules. • Review work queues and charge edit reports daily. • Intervene directly in complex or high-risk coding scenarios. • Participate in denial root cause reviews related to coding or charge capture. • Collaborate with AR leadership to address downcoding, bundling, and medical necessity denials. • Monitor and reduce coding-related denial rates. • Conduct detailed vendor performance reviews, including QC results and productivity tracking. • Escalate deficiencies and require documented remediation plans. • Participate directly in operational calls to review aging, denials, and backlog. • Evaluate cost effectiveness and recommend insourcing when appropriate. • Directly manage coding supervisors, leads, and charge entry staff. • Set clear productivity and accuracy expectations. • Conduct performance reviews and coaching sessions. • Provide ongoing education and specialty-specific training. • Develop high-performing coders with expertise in complex surgical and procedural coding (if applicable). • Partner with physicians and practice leadership to improve documentation quality. • Work closely with Revenue Cycle leadership to improve clean claim rates. • Collaborate with IT on system edits, charge interfaces, and automation. • Support new service lines and acquisitions with coding setup and charge master validation. • Track and report on key performance indicators: Coding accuracy rate, Productivity benchmarks, Charge lag days, Coding-related denial rate, Unbilled inventory. • Provide monthly reporting and operational improvement plans to RCM leadership.

🎯 Requirements

• Bachelor’s degree or equivalent work experience. • CPC, CCS-P, or equivalent professional coding certification required. • 5–8+ years of progressive coding experience, including leadership. • Experience in orthopedic, multi-specialty physician practices or large healthcare organizations. • Strong knowledge of payer reimbursement methodologies. • Experience managing high-volume professional coding environments. • Proficiency in EHR and practice management systems. • Strong technical coding expertise. • Operational discipline and workflow management. • Detail orientation. • Regulatory compliance. • Team leadership and accountability. • Data-driven decision making. • Problem-solving and escalation management.

🏖️ Benefits

• Excellent growth and advancement opportunities • Dynamic environment • Access to a diverse network of practitioners • Broad infrastructure of tools and programs to enhance the employee experience • Competitive Compensation • Generous PTO • Benefits package: health, dental, vision, 401(k), etc.