Manager, HIM Professional Billing Coding - FT - Days - HIMS - Medical Records @ MV

Core Duties

• Primary lead educator with sessions onsite and in electronic format for new and existing providers/clinicians.
• Oversee the professional coding of evaluation & management (E/M), surgical, and diagnostic services.
• Ensure accurate CPT, HCPCS, and ICD-10-CM code assignment by physicians for all PB claims.
• Monitor coding compliance with CMS, OIG, payer-specific guidelines, and organizational policy.
• Maintains providers monthly audits and reports to the ECHMN compliance committee.
• Extracts and uploads audited data from third-party vendors and coordinate other team members’ assignments in maintaining all monthly audits are completed in a timely manner.
• Works closely with Revenue Integrity and Billing to streamline processes and resolve coding/billing issues.
• Maintain communication with leadership regarding trends, backlogs, and regulatory changes.
• Conducts internal and external auditing of coding staff team members by providing educational monthly reporting to reduce claim denials for ECHMN medical documentation by updating ECH Professional Coding Guidelines and creation of monthly educational newsletters to the El Camino Health Medical Network.
• Coordinates with the facility HIM coding manager with professional surgical and obstetrical coding of claims.
• Ensures department goals and KPIs (e.g., coding reviews/release of provider’s charges turnaround times, and quality scores) are met.

Qualifications

• Minimum (5) years of professional coding/auditing experience in a multispecialty healthcare setting for professional physicians claims to include evaluation and management services, ICD-10-CM diagnosis, HCPCS, and CPT coding for both inpatient and outpatient services, required.
• At least 5 years of experience in a supervisory or management role within the HIM Coding department preferred.
• In-depth knowledge of physician coding across specialties, E/M leveling, surgical coding, and modifier usage.
• Electronic Health Records (EHR): EPIC or equivalent enterprise EHR systems experience Required.
• Experience with EPIC’s PB module (Professional Billing) strongly preferred.
• Coding and Billing Tools: Epic AI tools.
• Reporting & Analytics: Proficient in MS Excel to include pivot tables, and VLOOKUPs), Word, and PowerPoint.
• Familiarity with reporting tools such as EPIC Clarity, Crystal Reports, Tableau, or Power BI a plus.
• Exposure to compliance software tools for audit management, and knowledge of OIG work plans, CMS NCCI edits, and payer policies.
• Revenue cycle knowledge of claims reimbursement associated with CMS LCD and NCD policies.
• Demonstrate excellent oral and written communication and presentation skills.
• Strong leadership, communication, interdepartmental collaborative relationships and conflict resolution skills.
• Strong organizational skills and ability to prioritize multiple activities and objectives in given timelines.
• Creative in problem solving skills and able to work under pressure and continuous change.
• High attention to detail with excellent problem-solving abilities with ability to interpret complex regulatory and payer guidelines.

Qualifications (continued)

• Certified Professional Coder (CPC) and Certified Professional Medical Auditor) CPMA or Certified Evaluation and Management Coder CEMC required.
• Certified Coding Specialist – Physician Based (CCS-P) – AHIMA, RHIT or RHIA preferred.
• Valid California Driver’s license.