Manager, Revenue Cycle and Auditing

Principal Responsibilities

• Lead, develop, and evaluate coding and auditing staff; set performance goals and foster accountability, equity, and continuous improvement.
• Oversee daily workflows, work queues, and staffing to meet productivity, quality, and SLA standards.
• Manage budgets and forecast staffing/resources to support volume, accuracy, and compliance needs.
• Standardize policies, procedures, and controls to ensure consistent, efficient, and compliant operations.
• Institute and oversee internal and external coder audits; ensuring a high degree of quality and accuracy of coding.
• Partner with providers to improve documentation, medical necessity support, and coding accuracy.
• Oversee coding, billing, and documentation audits, including audit plans, sampling, scoring, and corrective actions.
• Monitor and optimize claim editing and encoding systems; analyze coding denial and coding edit trends and implement sustainable fixes.
• Establish monitoring systems to ensure adherence to Medicare/Medicaid regulations, payer policies, and organizational standards.
• Develop and deliver coding and billing education for clinical and non-clinical staff, including new provider onboarding.
• Publish guidance and tools that translate regulations into clear, operational workflows.
• Analyze coding and medical necessity denials; lead root-cause analysis and implement prevention strategies.
• Collaborate with revenue cycle teams to improve first-pass yield, reduce rework, and compliantly enhance reimbursement.
• Recommend and implement process and technology improvements to boost clean-claim rates and reduce A/R days.
• Monitor KPIs, conduct trend analyses, and present performance and risk updates to leadership.
• Serve as a subject matter expert on coding, compliance, and revenue cycle best practices; stay current on regulatory changes.
• Lead continuous improvement initiatives to streamline workflows and improve the provider/patient and employee experience.
• Ensure timely, professional responses to provider, patient, and payer inquiries related to coding and reimbursement.

Education/Experience

• Bachelor of Science in Health Information Management degree or equivalent required, master’s degree in business or finance related field preferred.
• CPC (Certified Professional Coder) Certification required within 1 year of hire.
• CCS-P (Certified Coding Specialist-Physician based) Certification required within 2 years of hire.
• RHIA (Registered Health Information Administrator) Certification required.

Knowledge, Skills And Abilities

• Excellent verbal and written communication; conflict and problem resolution skills.
• Excellent strategic, analytical and process systems thinking skills.
• Demonstrated expertise with Teams, Excel, Visio, PowerPoint and other Microsoft Office products.
• Excellent interpersonal skills, including ability to understand and articulate the needs of stakeholders and assist them in making the decisions necessary to accomplish their objectives.
• Demonstrated ability in earning and maintaining credibility with leaders across the organization.
• Ability to respectfully and collaboratively challenge team members to perform within designated timelines.

Working Environment

• Requires sitting and standing for periods of time working in an office environment.
• Use of telephone required.
• Some bending and stretching required.
• PHI/Privacy Level: HIPAA1