Job Description

Job Description

Job Description

Salary:

About Plutus Health Inc.:

Plutus Health Inc. is a leading provider of Revenue Cycle Management (RCM) services, certified in SOC2 compliance and recognized among the Inc. 5000 fastest-growing private companies. We specialize in revenue cycle optimization for hospitals, physician groups, and healthcare organizations across various specialties. Our commitment to innovation and excellence has earned us recognition as a 2024 EY Entrepreneur Of The Year finalist and one of the top 100 fastest-growing companies in Dallas.

Job Description:

We are seeking an experienced Client Success Manager (CSM) with expertise in medical coding, auditing, and compliance to oversee client relationships, coding operations, and revenue cycle optimization. This role requires a deep understanding of CPT, ICD-10, HCPCS, payer policies, and denial management, ensuring that clients receive best-in-class coding services and compliance support.

The ideal candidate will have a strong background in medical coding, compliance audits, RCM workflow optimization, and payer regulations, along with exceptional client relationship management skills.

Key Responsibilities:

Client Success & Relationship Management:

• Serve as the primary point of contact for clients, ensuring smooth communication and resolution of coding-related concerns.
  
• Develop and implement client engagement strategies to maximize satisfaction, retention, and revenue growth.
  
• Conduct Quarterly Business Reviews (QBRs) and compliance audits to drive process improvements.
  
• Identify upsell and cross-sell opportunities within client accounts to expand coding service offerings.
  

Medical Coding & Compliance Oversight:

• Ensure adherence to ICD-10, CPT, HCPCS, and payer-specific guidelines across multiple specialties.
  
• Conduct coding audits, documentation reviews, and risk assessments to improve coding accuracy and compliance.
  
• Monitor denial trends, coding discrepancies, and revenue leakage, implementing corrective actions as needed.
  
• Stay up to date with Medicare, Medicaid, and commercial payer regulations, ensuring regulatory compliance.
  
• Provide training and education to clients and internal teams on evolving coding guidelines and best practices.
  

Revenue Cycle & Denial Management:

• Optimize coding workflows, ensuring efficient charge capture and clean claim submission.
  
• Collaborate with billing, AR, and denial management teams to reduce denials, enhance revenue recovery, and improve coding accuracy.
  
• Track key performance indicators (KPIs) such as clean claim rates, denial rates, coding accuracy, and compliance scores.
  
• Drive coding automation initiatives to improve operational efficiency and minimize manual errors.
  

Cross-Functional Collaboration & Leadership:

• Work closely with operations, compliance, and technology teams to refine and enhance coding service offerings.
  
• Lead and mentor onshore and offshore coding teams, ensuring high performance and adherence to compliance standards.
  
• Partner with business development teams to support client onboarding, process improvement initiatives, and contract renewals.
  
• Act as an RCM Subject Matter Expert (SME) in internal strategy discussions and client engagements.
  

Required Qualifications :

• Bachelors degree in Healthcare Administration, Business, or a related field (Masters preferred).
  
• 7+ years of experience in medical coding, auditing, and revenue cycle management in a leadership role.
  
• Certification required: CPC, CCS, or equivalent (AHIMA or AAPC certification preferred).
  
• Strong understanding of payer policies, claims processing, medical necessity guidelines, and risk adjustment methodologies.
  
• Experience in coding audits, denial resolution, and revenue integrity initiatives.
  
• Proficiency in RCM platforms, EHR/EMR systems (Epic, Meditech, Paragon, etc.).
  
• Experience managing onshore/offshore coding teams and handling multi-client engagements.
  
• Strong analytical, problem-solving, and negotiation skills with the ability to translate data into actionable insights.
  
• Willingness to travel as needed.
  

Why Join Plutus Health Inc.?

• Work for a fast-growing, innovative company recognized for excellence in healthcare.
• Collaborate with a dynamic, supportive team that values professional development.
• Make a meaningful impact on patient care and operational success.

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