New Season
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Billing Compliance Manager
role at
New Season
Job Summary The Billing Compliance Manager provides oversight of coding operations with a focus on behavioral health and outpatient facility services. This role ensures coding accuracy, documentation integrity, and compliance with federal, state, and payor regulations through internal audits, payer reviews, and accreditation-related activities. The position provides feedback, education, and training on the results of auditing. The individual is also responsible for carrying out the requirements and elements of an effective compliance program and enforcing HIPAA Privacy requirements, identifying risks and trends, developing effective internal controls, and providing education and feedback to staff and physicians. By maintaining rigorous compliance standards, this position supports accurate reimbursement, minimizes organizational risk, and upholds the quality and integrity of all coding and billing functions.
Essential Functions
Conduct regular audits of medical coding, billing, and documentation for accuracy and compliance with ICD-10, CPT, HCPCS, CMS, and payer-specific guidelines.
Audit pre-bill encounters, identifying discrepancies, coding errors, and compliance risks.
Ensure adherence to all applicable regulations, including HIPAA Privacy and Security requirements, and support ongoing compliance program initiatives.
Conduct remote and on-site chart audits, including clinical observations, HIPAA compliance checks, education/supervision, and corrective action planning.
Document audit findings clearly and concisely, communicating results through written reports, feedback calls, and structured presentations to leadership.
Prepare audit conclusion reports that summarize findings, identify trends, and recommend corrective actions and process improvements.
Collaborate with operational leaders to implement and monitor corrective action plans.
Provide timely education, feedback, and coaching to providers, coders, and revenue cycle staff on audit results and coding requirements.
Support performance improvement by meeting directly with physicians/clinicians or equipping practice managers and leadership with guidance for discussions.
Develop and present compliance training programs, including updates on regulatory changes, coding guidelines, and payer requirements.
Maintain current knowledge of coding regulations, accreditation standards (e.g., CARF), and industry best practices to ensure organizational alignment.
Assist in carrying out the functions of the Compliance Program as directed by the SVP of Compliance and Risk and/or the Executive Leadership Team.
Gather and analyze compliance data to identify risks, trends, and areas requiring further monitoring or training.
Provide support through in-person meetings, virtual sessions, email, or phone for compliance-related issues.
Prepare reports and updates for compliance leadership, executive teams, and regulatory purposes as requested.
Assist in planning and executing audit projects from initiation through completion, including scheduling, data gathering, and follow-up tracking.
Maintain compliance with all organizational policies and procedures while supporting operational efficiency and integrity.
Provide administrative support as needed, including scheduling meetings, preparing documentation, and maintaining calendars.
Supervisory Responsibilities
Provide direct supervision, coaching, and performance management for coding and compliance staff.
Establish clear performance expectations, goals, and accountability measures for team members.
Monitor workload distribution, audit assignments, and staff productivity to ensure timely and accurate completion of responsibilities.
Conduct regular performance reviews, deliver constructive feedback and identify opportunities for growth and development.
Oversee staff training and continuing education related to coding accuracy, compliance requirements, and regulatory changes.
Support recruitment, onboarding, and retention of qualified coding and compliance personnel.
Foster a culture of integrity, compliance, and continuous improvement within the team.
Serve as an escalation point for complex coding or compliance issues, providing guidance and resolution.
Essential Qualifications
Education: Bachelor’s degree in health information management or related field and Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent coding certification required. Certified Professional Medical Auditor (CPMA) or similar auditing credential preferred.
Required Knowledge: Knowledge of Methadone Maintenance Treatment; detail oriented; strong clerical skills; broad knowledge of revenue cycle, Common Procedure Terminology Codes, ICD-10 and associated experience in billing and auditing; deep understanding of compliance documentation and billing for healthcare providers; understanding of Medicaid and other third‑party requirements; proficiency in Microsoft and Google products.
Experience Required: Minimum of 5 years experience in coding and billing for substance abuse treatment; Minimum of 2‑year auditing experience in the healthcare industry; demonstrated experience utilizing electronic spreadsheets such as Google Sheet or Excel; team skills, integrity, confidence.
Skill and Ability: Work with technical and administrative personnel; strong organizational skills; meet deadlines; handle sensitive confidential information; excellent communicator; strong administrative and data management skills; proactive issue raising; customer service; knowledge of state and federal regulations.
Physical Demands/Work Environment: Sedentary work; lifting up to 10 pounds; ability to travel up to 75% annually; remote work allowed; moderate noise environment; adaptability.
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Billing Compliance Manager
role at
New Season
Job Summary The Billing Compliance Manager provides oversight of coding operations with a focus on behavioral health and outpatient facility services. This role ensures coding accuracy, documentation integrity, and compliance with federal, state, and payor regulations through internal audits, payer reviews, and accreditation-related activities. The position provides feedback, education, and training on the results of auditing. The individual is also responsible for carrying out the requirements and elements of an effective compliance program and enforcing HIPAA Privacy requirements, identifying risks and trends, developing effective internal controls, and providing education and feedback to staff and physicians. By maintaining rigorous compliance standards, this position supports accurate reimbursement, minimizes organizational risk, and upholds the quality and integrity of all coding and billing functions.
Essential Functions
Conduct regular audits of medical coding, billing, and documentation for accuracy and compliance with ICD-10, CPT, HCPCS, CMS, and payer-specific guidelines.
Audit pre-bill encounters, identifying discrepancies, coding errors, and compliance risks.
Ensure adherence to all applicable regulations, including HIPAA Privacy and Security requirements, and support ongoing compliance program initiatives.
Conduct remote and on-site chart audits, including clinical observations, HIPAA compliance checks, education/supervision, and corrective action planning.
Document audit findings clearly and concisely, communicating results through written reports, feedback calls, and structured presentations to leadership.
Prepare audit conclusion reports that summarize findings, identify trends, and recommend corrective actions and process improvements.
Collaborate with operational leaders to implement and monitor corrective action plans.
Provide timely education, feedback, and coaching to providers, coders, and revenue cycle staff on audit results and coding requirements.
Support performance improvement by meeting directly with physicians/clinicians or equipping practice managers and leadership with guidance for discussions.
Develop and present compliance training programs, including updates on regulatory changes, coding guidelines, and payer requirements.
Maintain current knowledge of coding regulations, accreditation standards (e.g., CARF), and industry best practices to ensure organizational alignment.
Assist in carrying out the functions of the Compliance Program as directed by the SVP of Compliance and Risk and/or the Executive Leadership Team.
Gather and analyze compliance data to identify risks, trends, and areas requiring further monitoring or training.
Provide support through in-person meetings, virtual sessions, email, or phone for compliance-related issues.
Prepare reports and updates for compliance leadership, executive teams, and regulatory purposes as requested.
Assist in planning and executing audit projects from initiation through completion, including scheduling, data gathering, and follow-up tracking.
Maintain compliance with all organizational policies and procedures while supporting operational efficiency and integrity.
Provide administrative support as needed, including scheduling meetings, preparing documentation, and maintaining calendars.
Supervisory Responsibilities
Provide direct supervision, coaching, and performance management for coding and compliance staff.
Establish clear performance expectations, goals, and accountability measures for team members.
Monitor workload distribution, audit assignments, and staff productivity to ensure timely and accurate completion of responsibilities.
Conduct regular performance reviews, deliver constructive feedback and identify opportunities for growth and development.
Oversee staff training and continuing education related to coding accuracy, compliance requirements, and regulatory changes.
Support recruitment, onboarding, and retention of qualified coding and compliance personnel.
Foster a culture of integrity, compliance, and continuous improvement within the team.
Serve as an escalation point for complex coding or compliance issues, providing guidance and resolution.
Essential Qualifications
Education: Bachelor’s degree in health information management or related field and Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent coding certification required. Certified Professional Medical Auditor (CPMA) or similar auditing credential preferred.
Required Knowledge: Knowledge of Methadone Maintenance Treatment; detail oriented; strong clerical skills; broad knowledge of revenue cycle, Common Procedure Terminology Codes, ICD-10 and associated experience in billing and auditing; deep understanding of compliance documentation and billing for healthcare providers; understanding of Medicaid and other third‑party requirements; proficiency in Microsoft and Google products.
Experience Required: Minimum of 5 years experience in coding and billing for substance abuse treatment; Minimum of 2‑year auditing experience in the healthcare industry; demonstrated experience utilizing electronic spreadsheets such as Google Sheet or Excel; team skills, integrity, confidence.
Skill and Ability: Work with technical and administrative personnel; strong organizational skills; meet deadlines; handle sensitive confidential information; excellent communicator; strong administrative and data management skills; proactive issue raising; customer service; knowledge of state and federal regulations.
Physical Demands/Work Environment: Sedentary work; lifting up to 10 pounds; ability to travel up to 75% annually; remote work allowed; moderate noise environment; adaptability.
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