Manager, PB Coding Denials Integrity – Medical Specialties

This is a fully remote position, open to applicants in Alabama, +32 more states.

📋 Description

• Oversee and direct daily operations within the designated functional area.

• Assess processes to enhance efficiency, boost productivity, and promote standardized best practices throughout the Mid-Revenue Cycle.

• Ensure compliance with regulatory requirements, accreditation standards, and organizational policies.

• Safeguard the confidentiality of patient records and report any suspected non-compliant practices.

• Utilize KPIs to evaluate effectiveness, monitor trends, and execute data-driven improvement strategies.

• Utilize healthcare technology and analytics tools to improve efficiency and support informed decision-making.

• Collaborate with clinical, IT, Compliance, and Revenue Cycle leaders to integrate Mid-Revenue Cycle processes.

• Cultivate and sustain stakeholder relationships to facilitate communication, problem-solving, and operational alignment.

• Lead and develop a team, which includes hiring, performance evaluations, professional development, training, feedback, and career advancement.

• Direct strategic initiatives, manage timelines, and drive system enhancements.

• Provide support to PB Medical Specialties including Laboratory, Pathology, Behavioral Health, Pediatrics development, Allergy and Immunology, Dermatology, Gastroenterology, Hepatology, Infectious Disease, Endocrinology, Nephrology, Rheumatology, Pulmonology, Sleep, VH, MFM, OB/GYN, OB GYN/Repro Endo, and UROGYN.

• Work Monday to Friday during the first shift, totaling 40 hours per week.

• Travel may be necessary.

⛳️ Requirements

• Coding Certification from the American Academy of Coders (AAPC) or the American Health Information Management Association (AHIMA).

• Relevant industry certification from a recognized accrediting body.

• Bachelor’s degree in health information management, Healthcare Administration, or a related field, or equivalent experience.

• At least 8 years of experience in mid-revenue cycle operations, coding, HIM, or healthcare technology.

• A minimum of 2 years of leadership experience in a large integrated healthcare system.

• Familiarity with facility coding, professional coding, and HIM operational guidelines and workflows.

• Understanding of third-party reimbursement programs, state and federal regulatory requirements, national and local coverage decisions, and coding classification systems (ICD-10, CPT, HCPCS).

• Capability to organize, compile, and analyze data from diverse sources.

• Strong knowledge of EHR systems and revenue cycle technology solutions.

• Proficient in Microsoft 365, including Teams, SharePoint, Word, Excel, PowerPoint, and Access.

• Experience in optimizing workflows and enhancing operational effectiveness within a complex healthcare setting.

• Ability to prioritize business needs and manage resources effectively.

• Demonstrated ability to lead teams, mentor staff, and promote continuous improvement and accountability.

• Ability to collaborate across multiple departments and navigate matrix organizational structures.

• Excellent interpersonal and cross-functional communication skills.

• Capacity to creatively identify and resolve problems, meet deadlines, and maintain precision and attention to detail.

• Ability to lift up to 40 lbs. occasionally.

• Capability to operate all necessary equipment to perform the job.

🏝️ Benefits

• Eligible for benefits.

• Premium pay options, including shift differentials, on-call pay, and more based on the teammate's role.

• Incentive pay available for select positions.

• Potential for annual pay increases based on performance.

• Paid Time Off programs.

• Medical, dental, vision, life, and Short- and Long-Term Disability benefits.

• Flexible Spending Accounts for qualifying health care and dependent care expenses.

• Adoption assistance and paid parental leave.

• Defined contribution retirement plans with employer matching.

• Additional financial wellness programs.

• Educational Assistance Program.

• Career development opportunities.

• Well-being programs.