Manager, Professional Billing Coding Operations

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

📋 Description

• Oversee the daily functions of the Professional Billing Coding Operations team.

• Supervise, develop, mentor, interview, orient, train, evaluate, hire, terminate, and discipline professional coding personnel as required.

• Ensure accurate assignment of CPT, HCPCS, ICD-10-CM, and diagnosis codes by coders, physicians, and non-physician practitioners.

• Examine medical records, abstract diagnoses and procedures, sequence codes, and guarantee precise professional billing.

• Analyze coding denials, payer claim edits, RAC reviews, and other external coding evaluations; pinpoint root causes and trends.

• Execute random chart audits and quality assessments to confirm compliant code selection and documentation.

• Deliver coding education, feedback, updates, and in-service training to coders, healthcare professionals, and Revenue Cycle personnel.

• Collaborate with the Coding Education Team to develop and implement coding, clinical documentation audits, and educational initiatives.

• Set staffing schedules, allocate workloads and projects, and oversee productivity.

• Monitor overtime, absenteeism, hours worked, leave, and vacation/sick time; evaluate and approve timesheets.

• Provide reports on coding accuracy, abstracting, coding responsibilities, benchmarking profiles, and operational performance.

• Investigate coding issues, address coding inquiries, initiate documentation queries, and track responses.

• Ensure adherence to Official Coding Rules, Coding Clinic guidance, payer protocols, CMS standards, HIPAA regulations, and hospital safety procedures.

⛳️ Requirements

• Bachelor's degree or an equivalent combination of formal education and experience.

• CPC – Certified Professional Coder certification is mandatory.

• Minimum of five years of coding experience, including education, mentoring, and training.

• At least five years of acute care hospital coding experience with ICD-10-CM and CPT-4.

• Minimum of three years of management experience is required; five years is preferred.

• Prior experience dealing with claim edits and denials.

• Exceptional understanding of ICD-10-CM, CPT-4/HCPCS coding conventions, and E&M coding.

• Familiarity with human anatomy, physiology, and pathology.

• Ability to provide hands-on education based on audit outcomes and needs.

• Strong knowledge of health records, computerized billing and charging systems, Microsoft applications, data integrity, and processing methodologies.

• Extensive understanding of hospital inpatient and outpatient reimbursement methods.

• Comprehensive knowledge of payer claim edits and payer denials.

• Profound knowledge of medical terminology, ICD-10-CM and CPT-4 coding conventions, CMS National Coverage Determinations, and relevant coding regulations and laws.

• Excellent organizational, prioritization, multitasking, follow-through, problem-solving, accuracy, and attention-to-detail abilities.

• Capability to collaborate with healthcare delivery teams, manage interruptions, adapt to changes in workload and schedule, and respond to urgent requests.

• Ability to mentor, guide, and inspire direct reports.

• Must uphold strict confidentiality of personal and health-sensitive information and ensure HIPAA compliance.

• Completion of a background check is required prior to employment.

• Must be vaccinated against COVID-19 and flu and receive a COVID-19 booster dose.

🏝️ Benefits

• Medical, dental, vision, and pharmacy benefits.

• Discretionary annual bonuses.

• Merit increases.

• Flexible Spending Accounts.

• 403(b) savings matches.

• Paid time off.

• Opportunities for career advancement.

• Resources to support employee and family well-being.

• Employee vaccination requirement coverage/context: COVID-19 and flu vaccination and COVID-19 booster.

• Accommodation support during the application process.