Coding Quality Manager

This is a fully remote position, open to applicants in United States.

📋 Description

• Conduct both prospective and retrospective audits of outpatient and professional surgical coding, encompassing CPT, ICD-10-CM, modifier assignments, Official Coding Guidelines, NCCI/OCE edits, and payer policies.

• Assist in the maintenance of the coding quality assurance program, which includes audit methodologies, scoring, documentation standards, and quality tracking processes.

• Evaluate audit results and quality trends to pinpoint areas of risk, educational requirements, and opportunities for process enhancement.

• Create and deliver focused educational sessions for coders and providers, including remediation, training workshops, and client-specific instruction.

• Compile client-facing audit summaries and reports that convey quality scores, trends, and suggested actions.

• Collaborate with Coding Operations and cross-functional teams to refine workflows, standardize best practices, and meet quality and service-level expectations.

• Offer expert-level assistance for complex coding inquiries across Ambulatory Surgery Centers and Professional Fee services.

• Engage in quality and compliance initiatives, which include follow-up audits, corrective-action monitoring, and validation of improvement results.

• Take part in special projects related to audits, quality enhancement, workflow improvements, client onboarding, and ongoing client support.

⛳️ Requirements

• 8–10+ years of coding experience, specifically in outpatient and/or professional surgical coding.

• Over 5 years of experience in coding quality auditing and/or coding education.

• Advanced understanding of CPT, ICD-10-CM, modifier usage, Medicare regulations, OPPS, and payer policies.

• Familiarity with surgical specialties such as orthopedics, spine, pain management, ophthalmology, and general surgery.

• Exceptional written and verbal communication skills, including the ability to educate clients and deliver presentations effectively.

• Strong analytical skills to interpret audit data and transform findings into practical educational materials.

• Highly organized, capable of managing multiple priorities and adhering to deadlines in a fast-paced, remote setting.

• Self-motivated and solution-oriented with robust critical thinking and problem-solving skills.

• Proficient in Microsoft Excel, Word, PowerPoint, and SharePoint.

🏝️ Benefits

• Opportunity to become part of a well-established and leading brand in a rapidly growing market.

• Gain valuable experience while working closely with Executive leadership.

• Engage in a positive culture-building environment.

• Enjoy a fully remote work arrangement.