Senior Manager Coding IP OP

About the Role

Under the general supervision of the Clinical Documentation and Coding Integrity (CDCI) Director, the Senior Manager of Coding, IP/OP guides inpatient (IP) and outpatient (OP) coding and reimbursement practices for BMC South and Brighton within established regulatory and organizational guidelines. This role provides direct oversight and supervision of coding staff and related workflows, develops and maintains coding guidelines, and ensures compliance with federal, state, and institutional regulations.

Responsibilities

• Oversees daily inpatient (IP) and outpatient (OP) coding and reimbursement practices across BMC South and Brighton to ensure consistent application of regulatory and organizational coding standards.
• Develops, implements, and maintains standardized coding guidelines for inpatient and outpatient services, integrating updates from the Official Coding Guidelines and Coding Clinic.
• Reviews and analyzes complex billing edits, claim reports, and coding-related discrepancies to support accurate DRG and APC/APG assignments and execute corrections.
• Enforces strict organizational compliance with applicable coding rules, official regulations, and internal policies by systematically monitoring coding practices and addressing deviations.
• Conducts routine, structured data quality reviews of coded medical records to evaluate accuracy, consistency, and adherence to national documentation and coding requirements.
• Coordinates, designs, and delivers technical training and educational programs for coding staff regarding regulatory updates, advanced coding standards, and organizational policies.
• Manages and coordinates institutional responses to external audits, including Recovery Audit Contractor (RAC) reviews and commercial payer audits, ensuring timely submission of documentation.
• Resolves complex coding-related denial cases by reviewing determinations, validating historical coding accuracy, and preparing clinical appeals or supporting documentation.
• Represents the Coding Department at interdisciplinary and clinical meetings to provide technical expertise on coding rules, documentation interpretation, and reimbursement implications.

Requirements

• Bachelor’s Degree in Health Information Management or a related field.
• Minimum of five years of acute care hospital coding experience with ICD-10-CM/PCS, including at least three years of healthcare management experience; or an equivalent combination of education and experience.
• Certified Coding Specialist (CCS) credential.

Preferred Qualifications

• Five years of healthcare management experience in an academic medical setting or trauma center, with experience utilizing Current Procedural Terminology (CPT-4).
• Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) credential.

Skills

• Reimbursement Methodologies: Extensive knowledge of hospital inpatient and outpatient reimbursement methodologies, including DRG systems such as CMS DRGs, AP-DRGs, and APR-DRGs.
• Clinical Knowledge: In-depth knowledge of medical terminology, anatomy, physiology, and pathology as they relate to accurate clinical coding and reimbursement assignment.
• Coding Systems: Advanced, fluent knowledge of ICD-10-CM/PCS and CPT coding systems, including Official Coding Guidelines and regulatory coding conventions.
• Systems Proficiency: Strong understanding of health information systems, data integrity principles, and electronic health record (EHR) workflows, alongside proficiency in Microsoft Office applications.
• Analytical Skills: Ability to interpret complex clinical and coding data to isolate systemic issues, resolve discrepancies, and apply regulatory and organizational policies appropriately.
• Time Management: Strong organizational and time management skills, including the ability to prioritize competing operational demands and meet tight compliance deadlines.
• Leadership & Coaching: Ability to provide structured guidance, coaching, mentoring, and informal leadership to coding staff to model best practices in coding accuracy and compliance.
• Regulatory Compliance: Ability to maintain strict confidentiality and ensure compliance with HIPAA and other privacy regulations when handling sensitive health information.

Pay

Compensation range: $97,500.00 - $141,500.00. 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 this 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.
• Career advancement opportunities.
• Resources to support employee and family well-being.

Schedule

Full Time.