Manager, Professional Billing Coding Operations

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

📋 Description

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

• Ensure accurate assignment of CPT, HCPCS, and diagnosis codes.

• Examine medical records and abstract diagnoses and procedures utilizing ICD-10-CM and CPT-4/HCPCS.

• Organize diagnoses, procedures, and complications in accordance with coding and regulatory standards.

• Address and resolve coding inquiries, edits, denials, and accountability issues.

• Conduct random audits of charts and perform quality reviews.

• Analyze benchmarking profiles and report on coding accuracy and abstraction outcomes.

• Offer coding updates, investigate coding concerns, and clarify documentation with medical personnel.

• Manage, develop, mentor, interview, orient, train, evaluate, hire, terminate, and discipline coding personnel as necessary.

• Create staffing schedules and allocate workloads and projects effectively.

• Provide coding and documentation training for healthcare professionals, coders, and Revenue Cycle staff.

• Formulate strategies to enhance coding efficiency and team productivity.

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

• Participate in coding and reimbursement meetings.

• Assist with RAC and other external coding reviews and payer audits.

• Adhere to hospital infection control and safety protocols.

⛳️ Requirements

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

• CPC – Certified Professional Coder certification.

• A minimum of five years of coding experience, including education, mentoring, and training aspects.

• At least five years of acute care hospital coding experience with ICD-10-CM and CPT-4; experience in an academic medical setting or trauma center is preferred.

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

• Previous experience dealing with claim edits and denials.

• Strong understanding of ICD-10-CM and CPT4/HCPCS coding conventions, including E&M coding.

• Knowledge of human anatomy, physiology, and pathology.

• Proficient in providing hands-on education to PB Coding Operations staff.

• Strong familiarity with health records, computerized billing and charging systems, Microsoft applications, data integrity, and processing techniques.

• Understanding of hospital inpatient and outpatient reimbursement methodologies.

• Awareness of payer claim edits and denials.

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

• Ability to uphold HIPAA confidentiality and compliance.

• Exceptional organizational, problem-solving, multitasking, prioritization, and follow-through capabilities.

• Capacity to mentor, guide, and motivate direct reports.

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

🏝️ Benefits

• Medical, dental, vision, and pharmacy benefits.

• Discretionary annual bonuses.

• Merit-based salary increases.

• Flexible Spending Accounts.

• 403(b) retirement savings matches.

• Paid time off.

• Opportunities for career advancement.

• Resources to support employee and family well-being.