Physician Coding Manager
AMN Healthcare
- New York, New York, United States
- New York, New York, United States
À propos
Lead daily physician coding operations across designated specialties and service lines within a Level I Trauma health system. Oversee coding workflow, work queue prioritization, productivity, quality, turnaround time, and timely claim release. Ensure adequate staffing coverage, workload balancing, and operational continuity across all assigned coding functions. Monitor coding volumes, DNFB-related coding impacts, edits, holds, and claim delays; implement corrective action plans as needed. Establish and maintain performance expectations, service level standards, and accountability measures for coding staff.
2. Professional Coding Oversight
Ensure accurate assignment of CPT, HCPCS, ICD-10-CM, modifiers, charge capture elements, and applicable professional fee coding requirements. Oversee coding for complex physician services including, but not limited to: trauma, emergency department, critical care, hospitalist/intensivist, surgery and procedural services, observation, multispecialty physician practice services. Ensure proper interpretation and application of payer guidelines, CMS regulations, AMA CPT guidance, NCCI edits, teaching physician rules, split/shared rules, and other professional billing requirements. Maintain consistent coding practices across specialties and providers to support compliance and reimbursement integrity.
3. Quality, Audit, and Compliance
Develop and oversee coding quality review and auditing processes to ensure coding accuracy, consistency, and regulatory compliance. Analyze audit findings, denial trends, payer takebacks, and documentation issues to identify education and performance improvement opportunities. Partner with Compliance, Revenue Integrity, CDI, and PFS leadership to mitigate coding risk and strengthen internal controls. Ensure adherence to all applicable federal, state, payer, and organizational coding and billing requirements. Support internal and external audits, including preparation of responses, corrective action plans, and ongoing risk monitoring.
4. Physician and Provider Education
Serve as a key resource for physicians, APPs, and operational leaders on professional coding, documentation requirements, and billing compliance. Develop and deliver targeted education related to E/M guidelines, trauma and critical care documentation, surgical/procedural coding, modifier usage, split/shared services, medical necessity, documentation specificity. Collaborate with physician leadership to drive engagement, improve documentation habits, and support compliant charge capture. Translate coding, denial, and audit trends into actionable provider education.
5. Team Leadership and Staff Development
Hire, onboard, train, coach, mentor, and evaluate physician coding staff. Build a high-performing team culture focused on accountability, collaboration, quality, service, and continuous improvement. Conduct regular staff meetings, one-on-ones, performance reviews, and development planning. Identify skill gaps and implement training, remediation, and competency development programs. Promote retention, succession planning, and professional growth within the coding team.
6. Data, Reporting, and Performance Management
Develop and monitor key performance indicators such as coding accuracy, productivity, work queue aging, denial rates, edit trends, charge lag, claim hold volumes, education effectiveness. Prepare and present operational reports to coding leadership, revenue cycle leadership, and other stakeholders. Use data to drive decisions, prioritize improvement efforts, and communicate departmental performance. Identify trends affecting reimbursement, compliance, or operational throughput and lead corrective action planning.
7. Systems, Workflow, and Process Improvement
Optimize physician coding workflows within the electronic health record, encoder, and billing systems. Partner with IT, Revenue Cycle, and operational leaders to improve work queues, edits, charge review functionality, and reporting tools. Support implementation and optimization of technologies such as Epic, 3M, CAC tools, and workflow automation. Lead or participate in projects involving process redesign, coding transitions, new service lines, regulatory updates, and system implementations. Drive standardization and best practices across physician coding operations.
8. Cross-Functional Collaboration
Partner with CDI, Revenue Integrity, Compliance, HIM, Patient Financial Services, physician practice operations, and clinical leadership to improve end-to-end revenue cycle performance. Collaborate with department leaders on documentation improvement, denial prevention, charge capture accuracy, and coding issue resolution. Serve as a subject matter expert and escalation point for complex coding and workflow issues. Support organizational initiatives related to revenue optimization, quality reporting, compliance readiness, and physician practice growth.
Qualifications Education
Bachelor's degree in Health Information Management, Healthcare Administration, Business, or related field required. Master's degree preferred.
Experience
Minimum 7–10 years of progressive coding experience in professional fee coding, physician billing, or revenue cycle operations. Minimum 3–5 years of leadership or supervisory experience in physician coding operations required. Strong experience in a large acute care hospital, academic medical center, trauma center, or integrated health system strongly preferred. Demonstrated experience with trauma, ED, surgery, hospitalist, and other high-acuity physician services preferred. Experience with coding audits, denials, provider education, and work queue/process management required.
Certifications One or more of the following required:
CPC CCS-P CCS RHIA RHIT CPMA preferred
Technical Knowledge
Expert knowledge of CPT, HCPCS, ICD-10-CM, E/M coding guidelines, NCCI edits, CMS billing and compliance rules, teaching physician and split/shared regulations, modifier application, medical necessity requirements. Proficiency with Epic, 3M, encoder systems, work queues, and reporting tools strongly preferred. Strong command of payer policies, denial prevention strategies, and physician documentation improvement practices.
Core Competencies
Physician coding expertise Trauma and emergency services knowledge Leadership and team development Regulatory and compliance acumen Provider education and influence Analytical thinking and problem-solving Operational excellence Change management Communication and collaboration Process improvement and systems optimization
Compétences linguistiques
- English
Avis aux utilisateurs
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