Manager Professional Billing Coding Operations - Remote

About the Role

Responsible for the operational functions of the Professional Coding Operations team for BUMG. Plays a strategic role in validating the accuracy of CPT, HCPCS, and diagnosis code assignment by coders, physicians, and non-physician practitioners. Works closely with key revenue cycle stakeholders to understand reasons for denials, perform root cause analysis, and provide feedback to providers. Supervises professional billing coding staff and partners with the Coding Education Team to identify trends in coding practices and develop feedback and education for providers.

Boston Medical Center (BMC) is the largest and busiest provider of trauma and emergency services in New England, emphasizing community-based care and serving as the largest safety-net hospital in the region. BMC is the primary teaching affiliate of Boston University School of Medicine and a founding partner of Boston HealthNet.

Responsibilities

• Reviews patient medical records and abstracts medical data to identify all diagnoses and procedures.
• Codes diagnoses, procedures, and appropriate modifiers using ICD-10-CM, CPT-4/HCPCS classification systems.
• Sequences diagnoses, procedures, and complications following ICD-10-CM, CPT-4, and UHDDS guidelines.
• Adheres to Official Guidelines for Coding and Reporting, Coding Clinic guidelines, and other regulatory requirements.
• Consults with medical staff to clarify medical record information.
• Maintains productivity standards and serves as a contact for professional billing coders regarding missing or incomplete information.
• Performs quality assurance reviews of inpatient and outpatient records to assess training program effectiveness and coder quality.
• Provides in-service training and feedback to coding staff, including coding updates.
• Oversees coding operations to ensure organizational goals are met.
• Designs and implements coding and clinical documentation audit and education programs to improve performance and efficiency.
• Enforces correct application of Official Coding Rules and Regulations and ensures compliance with payer guidelines.
• Oversees coding edits and denials, supporting RAC and other external coding reviews.
• Manages the day-to-day operations of the PB Coding Operations Team, including hiring, training, and evaluating staff.
• Establishes staffing schedules and assigns workloads based on volume.
• Conducts quality reviews to validate code selection compliance with established guidelines.
• Evaluates documentation for completeness and initiates queries when necessary.
• Provides training to healthcare professionals, coders, and Revenue Cycle staff on coding guidelines and documentation.
• Develops long-term strategies to improve efficiencies and increase team productivity.
• Tracks and responds to coding accountabilities from internal and external sources, including RAC reviews.
• Monitors overtime, absenteeism, and staff hours, and approves timesheets for payroll.
• Participates in coding and reimbursement meetings and maintains knowledge of ICD-10 and CPT classifications.

Requirements

• Bachelor’s degree or equivalent combination of formal education and experience.
• Certified Professional Coder (CPC) certification required.
• Minimum of five years of coding experience, including education, mentoring, or training.
• Minimum of five years of acute care hospital experience coding with ICD-10-CM and CPT-4; academic medical setting or trauma center preferred.
• Minimum of three years of management experience; five years preferred.
• Prior experience working with claim edits and denials.

Skills

• Excellent command of ICD-10-CM and CPT-4/HCPCS coding conventions, including E&M coding.
• Strong knowledge of human anatomy, physiology, and pathology.
• Ability to provide hands-on education to coding staff based on audit findings.
• Proficiency in health records, computerized billing systems, and Microsoft applications.
• Strong organizational skills, including multitasking, prioritization, and meeting deadlines.
• Ability to work accurately with attention to detail and solve problems using job knowledge and policies.
• Ability to work cooperatively with healthcare teams and adapt to changing workloads.
• Strict adherence to confidentiality and HIPAA compliance.
• Extensive knowledge of hospital inpatient and outpatient reimbursement methodologies.
• Ability to mentor, guide, and motivate direct reports.
• In-depth knowledge of medical terminology, coding regulations, and payer claim edits.

Pay

Compensation range: $78,000.00 - $113,000.00. This range is based on minimum job qualifications and considers factors such as education, experience, skills, certifications, business needs, internal equity, and market competitiveness. Geographic location may modify the range.

Benefits

• Medical, dental, vision, and pharmacy benefits.
• Discretionary annual bonuses and merit increases.
• Flexible Spending Accounts and 403(b) savings matches.
• Paid time off and career advancement opportunities.
• Resources to support employee and family well-being.

Schedule

Full Time