Spire Orthopedic Partners logo
Spire Orthopedic Partners

Driving the future of orthopedic medicine.

Associate Director – Billing, Coding

Billing SpecialistBilling SpecialistFull TimeRemoteSeniorTeam 1,001-5,000Since 2021H1B No SponsorCompany SiteLinkedIn

Location

Connecticut

Posted

10 days ago

Salary

$113.2K - $169.8K / year

Seniority

Senior

Bachelor Degree5 yrs expEnglish

Job Description

Associate Director – Billing, Coding

Spire Orthopedic Partners

• 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.

Job 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.

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