Manager, Coding Quality, Audit & Education

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

📋 Description

• Provide enterprise leadership for coding precision, audit oversight, regulatory adherence, and coder/physician education across inpatient, outpatient, and professional services.

• Disseminate updates on coding regulations, policies, and guideline modifications throughout the health system.

• Act as a coding resource and subject matter expert for Revenue Integrity departments, physicians, providers, and administration.

• Design and deliver coding compliance education and training initiatives.

• Mentor newly hired and contracted coding auditors and educators while monitoring team performance.

• Generate standardized monthly reports, final audit reports, executive summaries, and presentations.

• Maintain and revise the Coding Audit Policy as necessary.

• Ensure regular monthly or quarterly audits of both internal and contractor coders.

• Conduct and supervise retrospective, prospective, targeted, external, and internal coding audits.

• Implement standardized scoring methods and report on monitoring outcomes.

• Communicate audit results and recommendations to management, departments, coders, vendors, contractors, physicians, and providers.

• Assess the effectiveness of coding audits and education programs.

• Research and convey federal, state, payer, Medicare, Medi-Cal, ICD, CPT, and Coding Clinic requirements.

• Evaluate medical record documentation, identify trends and issues, and coordinate their resolution.

• Ensure accuracy and compliance of MS/APR DRG, APC, ICD-10-CM, CPT, and HCPCS assignments.

• Lead audits in inpatient, outpatient, and professional coding environments.

• Establish risk-based audit priorities informed by denial trends, volume, regulatory changes, and specialty variation.

• Create or update e-learning webinars for the Revenue Cycle Academy and physician onboarding education.

• Participate in faculty meetings, multidisciplinary committees, and code-dependent initiatives.

• Oversee the compliance work plan/program for accurate coding and auditing.

• Manage professional unlisted, custom, and special procedure codes.

• Collaborate with clinical, coding, compliance, revenue cycle, pricing, and finance stakeholders on new technologies, emerging procedures, and atypical services.

⛳️ Requirements

• Bachelor's Degree in a relevant field from an accredited college or university; relevant experience may be considered in lieu of a degree with approval.

• 5–7 years of progressively responsible experience directly related to coding, auditing, and education, including at least 2 years in these areas.

• Experience with EPIC is mandatory.

• Demonstrates advanced knowledge and skills in professional coding and/or outpatient & inpatient hospital coding environments.

• Exhibits advanced knowledge and skills in auditing & education within professional coding and/or outpatient & inpatient hospital coding settings.

• Capable of analyzing problems and understanding regulatory and reimbursement implications.

• Possesses critical thinking skills; able to assess, evaluate, and teach clinical concepts.

• Proficient in both written and verbal communication, including summarizing data and presenting findings.

• Advanced comprehension of regulatory guidelines and official coding advice.

• Ability to adhere to AHIMA Code of Ethics, Standards of Ethical Coding, and relevant UHDDS standards.

• Familiarity with HIPAA principles and provisions.

• Capability to establish and maintain effective working relationships.

• Competent in managing, organizing, prioritizing, multitasking, and adapting to shifting priorities.

• Proficient in computer skills for data input, manipulation, and output.

• Ability to function effectively as both a team player and leader.

• Familiarity with health information systems used in Health Information Management and hospital revenue cycle.

• Advanced knowledge of ICD-10-CM/PCS and CPT-4 coding.

• Comprehensive understanding of patient medical records standards, coding systems, medical terminology, anatomy, physiology, and diseases.

• Knowledge of privacy regulations and confidentiality requirements.

• CCS certification is mandatory.

• A Master's degree, 3+ years of experience in an academic medical center, auditing software experience, RHIT, RHIA, and CPC and/or CCSP certifications are preferred.

🏝️ Benefits

• Competitive salary and comprehensive benefits package.

• Opportunities for professional development and continuing education.

• Supportive work environment with a focus on teamwork and collaboration.