Outpatient Coder Program Manager

United States

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Not SpecifiedCompensation

Senior (5 to 8 years), Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

Health Insurance, HealthcareIndustries

Requirements

Candidates must possess a Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) certification and have a minimum of 5 years of experience in outpatient coding, auditing, and payment integrity compliance. Strong experience in coding audits and a proven ability to support audit processes, including provider escalations and appeals, are essential. A Registered Nurse (RN) license or clinical background is preferred, as is a Bachelor's Degree. Strong communication and interpersonal skills, experience with offshore vendors or remote teams, and the ability to manage multiple priorities in a fast-paced environment are also desired.

Responsibilities

The Outpatient Coder Program Manager will support inpatient and outpatient audit reviews by providing clinical and coding expertise, assisting with provider escalations and appeals, and participating in quality review activities. This role involves collaborating with various teams to identify documentation or coding issues, promoting consistency and accuracy in audit-related activities, and contributing to the development of educational materials and process improvements. The manager will also support program leadership by identifying trends in disputes or escalations and recommending corrective actions.

Skills

Inpatient Coding

Outpatient Coding

Audit Reviews

Clinical Review

Provider Escalations

Appeals

Coding Compliance

Documentation Review

Regulatory Standards

Devoted Health

Medicare Advantage plans with personalized support

About Devoted Health

Devoted Health provides Medicare Advantage plans aimed at simplifying and making healthcare more affordable for seniors aged 65 and older. Their plans include services like provider and pharmacy searches, prescription drug coverage, and preventive care rewards. Members pay premiums for these plans, and the company may also receive government payments for managing Medicare benefits. What sets Devoted Health apart from competitors is their high level of customer service, featuring Devoted Health Guides who assist members in navigating their healthcare options and addressing common issues with traditional insurance. Additionally, they promote preventive care through the Devoted Dollars program, which rewards members for engaging in health activities. The goal of Devoted Health is to create a more compassionate and accessible healthcare experience for its members.

Waltham, MassachusettsHeadquarters

2017Year Founded

$2,194.5MTotal Funding

SERIES_ECompany Stage

HealthcareIndustries

1,001-5,000Employees

Benefits

Comprehensive health plan

401(k) retirement plan

Generous vacation and holiday time

Lyra mental health resources

Time off to vote

Risks

Increased competition from Medicare Advantage providers like Clover Health and Oscar Health.

Potential regulatory changes affecting Medicare Advantage plans by CMS.

Rising healthcare costs could impact the affordability of Devoted Health's plans.

Differentiation

Devoted Health offers personalized assistance through Devoted Health Guides for member support.

The company emphasizes preventive care with its Devoted Dollars rewards program.

Devoted Health integrates virtual and in-home care with top local providers.

Upsides

Devoted Health raised $287 million in Series E funding in 2024.

The company expanded Medicare Advantage plans to eight new states in 2023.

Devoted Health achieved a 5-star Medicare Advantage rating in Ohio in 2023.

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