Manager of Professional Services - Clinical Coding, Quality, Risk and Compliance
Director of Professional Services – Clinical Coding, Quality, Risk and Compliance
Location: Remote
Reports To: Sr. Director of Virtual Care Systems (VCS)
FLSA Status: Exempt
Type: Full-Time
Position Summary
The Director of Professional Services – Clinical Coding, Quality, Risk and Compliance is a strategic leadership role responsible for overseeing the development, implementation, and management of coding and compliance programs specific to clinic and telehealth services for maternal care. This individual ensures adherence to federal and state regulations, payer guidelines, and industry best practices while driving operational excellence and client satisfaction. Additionally, the Director will lead initiatives to develop managed care partnerships focused on care coordination and improving health outcomes for high-risk pregnant women, supporting value-based care models and maternal health equity.
Key Responsibilities
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Lead and manage clinical and compliance team, including hiring, training, performance management, and professional development.
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Develop and implement policies and procedures to ensure accurate coding and billing practices for maternal clinical services.
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Monitor regulatory changes and payer updates related to telehealth and ensure timely integration into organizational practices.
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Conduct internal audits and risk assessments to identify compliance gaps and implement corrective actions.
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Serve as a subject matter expert on clinical coding (CPT, HCPCS, ICD-10) and compliance regulations (HIPAA, OIG, CMS).
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Collaborate with legal, IT, clinical, and operational teams to ensure cross-functional alignment and compliance.
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Provide strategic guidance to clinic clients on coding and compliance best practices.
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Develop and deliver training programs for internal staff and external clients.
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Represent the organization in industry forums, conferences, and with regulatory bodies as needed.
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Lead the development and management of managed care partnerships aimed at enhancing care coordination and improving maternal health outcomes, particularly for high-risk pregnant women.
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Collaborate with payers, providers, and community organizations to design and implement value-based care models and telehealth-enabled interventions.
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Analyze outcome data and quality metrics to assess program effectiveness and identify opportunities for improvement in maternal and perinatal care.
Qualifications
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Bachelor’s degree in Health Information Management, Healthcare Administration, Nursing, Public Health, or a related field (Master’s preferred).
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RHIA, RHIT, CCS, CPC, or similar coding certification required.
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Minimum of 7–10 years of experience in medical coding and compliance, with at least 3 years in a leadership role.
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Demonstrated experience in developing and managing managed care or payer-provider partnerships, particularly in maternal health or high-risk populations.
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Deep understanding of telehealth regulations, billing practices, and payer requirements.
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Proven experience managing teams and driving performance in a remote or hybrid environment.
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Strong analytical, communication, and project management skills.
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Experience with EHR systems and coding software tools.
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Familiarity with value-based care models, quality metrics, and care coordination strategies.