Senior Coding & Quality Specialist (MIPS)

About Us Ventra is a leading business solutions provider for facility-based physicians practicing anesthesia, emergency medicine, hospital medicine, pathology, and radiology. Focused on Revenue Cycle Management, Ventra partners with private practices, hospitals, health systems, and ambulatory surgery centers to deliver transparent and data-driven solutions that solve the most complex revenue and reimbursement issues, enabling clinicians to focus on providing outstanding care to their patients and communities. Job Summary The Senior Regulatory Affairs Specialist serves as a key leader in managing the Merit-Based Incentive Payment System (MIPS) for Hospital Medicine and Emergency Medicine clients. Reporting directly to the Director of Healthcare Quality —who oversees all MIPS initiatives enterprise-wide—this role supports the coordination, execution, and continuous improvement of the company’s quality reporting programs. The individual proactively reviews and interprets federal regulatory guidelines, develops specialty‑specific MIPS strategies, supports client communications, and ensures accurate, compliant, and timely quality reporting. This position works in close collaboration with Operations, Business Intelligence, Client Management, and other key stakeholders to deliver strong MIPS outcomes. A current Certified Professional Coder (CPC) credential is required. Essential Functions and Tasks MIPS Program Leadership (Primary Responsibility) Serves as the primary operational owner for MIPS within Hospital Medicine and Emergency Medicine specialties, under the direction of the Director of Healthcare Quality. Works on annual planning, measure selection, workflow design, and reporting strategies tailored to inpatient and emergency care environments. Conducts detailed MIPS data validation, including coding/documentation review, performance metric confirmation, and error troubleshooting. Assists with annual MIPS submission for clients, ensuring accuracy, completeness, timeliness, and documentation sufficient for audit readiness. Leads and coordinates internal MIPS meetings—providing updates, recommendations, and regulatory interpretation to Operations, Coding, BI, and Client Management teams. Serves as the central point of contact for all MIPS-related inquiries from internal departments and external clients for the Hospital Medicine and Emergency Medicine service lines. Tracks and analyzes specialty-specific MIPS performance trends and collaborates with internal teams to close data gaps, address compliance risks, or improve outcomes. Works directly with the Director of Healthcare Quality on all QPP Helpdesk escalations and regulatory clarifications. Develops and maintains internal guidance documents, workflows, SOPs, and educational materials to support consistent MIPS practices across the company. Regulatory & Quality Program Support Conducts detailed analysis of CMS regulations, policy updates, and quality program changes affecting Hospital Medicine and Emergency Medicine. Responds to regulatory audit requests, reviewing coding, documentation, and compliance requirements. Collaborates with Business Intelligence to build dashboards, performance monitoring tools, and reports tailored to MIPS performance. Prepares regulatory content for quarterly client updates and ensures specialty-specific accuracy for Client Managers. Manages and refines Regulatory Affairs Smartsheets, consolidating tools and improving tracking systems. Participates in client calls to review MIPS outcomes, provide regulatory insight, and support strategic planning. Supports the growth of the company’s Qualified Registry offerings relevant to Hospital Medicine and Emergency Medicine. Content & Knowledge Leadership Builds expertise in QPP/MIPS, medical necessity, documentation requirements, and coding for inpatient and ED encounters. Performs other related duties as assigned. Note: The above statements describe the general nature and level of work performed. They are not intended to be an exhaustive list of all responsibilities. Management may assign or reassign duties at any time. Education and Experience Requirements High school diploma or equivalent required. Current CPC (Certified Professional Coder) credential required. Minimum of two years administrative experience. Healthcare experience preferred. Regulatory affairs or quality reporting experience strongly preferred. Experience with Hospital Medicine and/or Emergency Medicine coding and documentation highly desirable. Knowledge, Skills, and Abilities Strong verbal and written communication skills. Proficiency with Windows and Microsoft Office products. Excellent critical thinking, data analysis, and regulatory research abilities. Strong organizational and prioritization skills. Ability to craft and refine client‑facing regulatory communications. Self‑directed, proactive, and able to work independently. Comfortable working in a fast‑paced, deadline‑driven environment. Compensation Base Compensation will be based on various factors unique to each candidate including geographic location, skill set, experience, qualifications, and other job-related reasons. This position is also eligible for a discretionary incentive bonus in accordance with company policies. Ventra Health Equal Employment Opportunity (Applicable only in the US) Ventra Health is an equal opportunity employer committed to fostering a culturally diverse organization. We strive for inclusiveness and a workplace where mutual respect is paramount. We encourage applications from a diverse pool of candidates, and all qualified applicants will receive consideration for employment without regard to race, color, ethnicity, religion, sex, age, national origin, disability, sexual orientation, gender identity and expression, or veteran status. We will provide reasonable accommodations to qualified individuals with disabilities, as needed, to assist them in performing essential job functions. #J-18808-Ljbffr Ventra Health, Inc.