Manager, Professional Medical Coding

About the Role

Manages the professional coding function and corresponding staff. Oversees auditing, quality control, and improvement initiatives to ensure compliance with internal policies, procedures, and governing agencies. Collaborates with the HIM/Coding Director to assist with departmental needs and planning.

Ensures compliant coding operations, quality coding, and abstraction of clinical data in accordance with established policies, regulations, procedures, and standards. Manages staff performance related to coding, communication with practices, and resolution of claim edits, denials, and procedures.

Responsibilities

• Manage professional coding staff and vendors performing professional coding and facilitate problem resolution of coding issues.
• Work with the Professional PFS department to resolve coding/billing issues, monitor, review, and address denial issues.
• Monitor discharged not final billed (DNFB) daily accounts receivable and other departmental metrics to achieve fiscal goals.
• Consistently monitor all EPIC work queues and confirm supervisory staff maintains performance and monitoring processes.
• Define, implement, and monitor strategies for improving documentation and develop physician education strategies with the validation team and MACC leadership.
• Develop and report performance measures to medical staff and other departments regarding documentation compliance.
• Collaborate with physicians, practice managers, MACC leadership, nursing staff, and other caregivers to improve documentation quality.
• Oversee daily operations of the Physician Coding Department and administer necessary education and training.
• Assess strengths of practitioners and staff involved in the coding process and recommend improvements.
• Serve as a resource for ongoing educational needs related to coding for physician practices and staff.
• Respond to practitioner and management questions regarding coding and reimbursement, researching as necessary.
• Assist in developing, implementing, and evaluating educational programs for coding applications and processes.
• Provide input for employee evaluations and develop/administrate Quality Improvement (QI) and compliance initiatives, including internal and external audits.
• Manage coding Key Performance Indicators (KPIs) and implement action plans when performance does not meet expectations.
• Assess direct reports’ performance consistently and provide feedback for improvement.
• Ensure coding employees and vendor staff comply with established policies, processes, and compliance programs.
• Support IT in testing modifications and troubleshooting issues for the EPIC system and related systems.
• Maintain current knowledge of coding and reimbursement rules, regulations, trends, and developments.
• Demonstrate sound judgment, strong organizational, problem-solving, and analytical skills.
• Provide service excellence to all patients, family members, visitors, volunteers, and co-workers.
• Identify process improvement opportunities and present recommendations to management.
• Engage in the organization’s culture of continuous improvement by supporting CCHC Pillars of Excellence.
• Perform other job-related duties as assigned.

Requirements

• Bachelor’s degree required or equivalent combination of education and experience. Master’s degree preferred.
• Current CCS (AHIMA Certified Coding Specialist) or CPC (AAPC Certified Professional Coder) certification required.
• Minimum of five years of progressive experience in multiple specialties of Professional Coding, including auditing and/or management.
• Strong working knowledge of medical terminology, anatomy and physiology, and reimbursement requirements.
• One to two years of supervisory experience of professional coding staff.
• Comprehensive understanding of Evaluation and Management (E&M) Coding and Specialty coding.
• Strong knowledge of fiscal intermediary and regulatory agency regulations for coding and provider reimbursement.

Qualifications

• Specialty in E&M (CEMC), Certified Evaluation and Management Coder through the AAPC, or CPMA, Certified Professional Medical Auditor through the AAPC preferred.
• Understanding of complex corporate relationships and ability to influence within such an environment.
• Demonstrated ability to use PC-based office productivity tools (e.g., Microsoft Office).
• Goal-oriented thinking, operational, and organizational skills.
• Ability to create training materials and deliver training, including large group presentations.
• Ability to communicate and present to a wide variety of internal and external stakeholders, including senior management, physicians, vendors, and consultants.
• Ability to work under pressure, manage multiple initiatives concurrently, and meet deadlines independently.

Schedule

Full-Time, Monday-Friday, no weekends or holidays.