COMPANY OVERVIEW

Theoria Medical is a comprehensive medical group and technology company dedicated to serving patients across the care continuum with an emphasis on post-acute care and primary care. Theoria serves facilities across the United States with a multitude of services to improve the quality of care delivered, refine facility processes, and enhance critical relationships. We offer a broad scope of services including multispecialty physician services, telemedicine, remote patient monitoring, and more. We currently operate primary care clinics and provide medical services to skilled nursing facilities in numerous states across the nation.
As a leading edge, innovative, and quality driven physician group, we continue to expand nationally. In pursuit of this, we continue to seek talented individuals to join our amazing team and care for our population. We wish to extend a warm welcome to all candidates interested in making a difference in healthcare delivery by joining the Theoria team
Theoria Medical is seeking a seasoned billing and coding expert with a proven track record to join our dynamic organization. The Manager of Coding, Billing, and Documentation Integrity is a hands-on leader responsible for driving accurate coding, compliant billing, and strong clinical documentation practices across our primary care operations. This role is focused on professional fee services, with an emphasis on E/M coding, chronic condition documentation, risk adjustment (HCC/RAF) capture, and denial prevention. The Manager works closely with providers to ensure clean claims, optimal reimbursement, and strong audit readiness.
This is an execution-heavy role ideal for someone who thrives in the weeds reviewing charts, leading provider education, running internal audits, and owning coding/billing workflows that directly impact revenue.

REQUIREMENTS AND QUALIFICATIONS

• Bachelor’s degree in Health Information Management, Healthcare Administration, or related field preferred
• CPC (Certified Professional Coder) mandatory
• One or more of: CRC, CPMA, CCS-P, RHIT, or RHIA
• 5+ years of experience in medical coding, documentation review, and billing compliance—focused on primary care services and nursing homes
• 3+ years in a senior-level coding or billing position (lead or supervisory role preferred)
• Strong knowledge of risk adjustment (HCC/RAF) and E/M coding
• Strong interpersonal and communication skills, with a proven ability to foster cross-departmental collaboration.

PHYSICAL REQUIREMENTS

• Ability to remain stationary for at least 50% of working hours.
• Ability to lift at least 25 pounds and maneuver to retrieve records or equipment as needed.
• Effective communication with internal and external stakeholders across facilities.

• Perform chart reviews to ensure proper ICD-10, CPT, and HCC coding across professional services.
• Educate providers on documentation standards for E/M leveling, time-based billing, and HCC coding.
• Partner with clinical leadership to improve diagnosis specificity and close coding gaps, if any.
• Ensure alignment between clinical documentation, coding, and claim submission.
• Monitor modifier usage, place-of-service accuracy, and billing edits to reduce denials.
• Review pre-bill and post-bill data to catch errors before claims are submitted.
• Collaborate with the billing team to respond to coding-related denials and payer inquiries.
• Conduct internal audits to measure documentation quality, coding accuracy, and billing compliance.
• Prepare reporting for leadership on trends, risk areas, and financial impact.
• Stay current on CMS guidelines, payer policies, and code set changes; update internal teams accordingly.
• Work closely with the VP of Revenue Cycle, compliance team, providers, and external coders.
• Create and lead training sessions and materials for clinical and billing staff.
• Support risk adjustment and value-based care initiatives with coding expertise and documentation insight.