Manager, Coding (67630)

Department : Billing

Position: Coding Manager

Employee Category :   Exempt

Reporting Relationship : Director, Revenue Cycle Management

Character First Qualities:

• Decisiveness- The ability to recognize key factors and finalize difficult decisions.
• Dependability- Fulfilling what I consented to do, even if it means unexpected sacrifice.
• Flexibility- Willingness to change plans or ideas without getting upset.
• Patience- Accepting a difficult situation without giving a deadline to remove it.
• Tolerance- Accepting others at different levels of maturity.

Summary of Duties and Responsibilities:

The Medical Coding Manager oversees the medical coding department, ensuring accurate and compliant coding practices across all service lines. This position is responsible for leading a team of medical coders, maintaining coding quality and productivity standards, implementing best practices, and serving as the organization's coding expert. The Manager works collaboratively with clinical staff, revenue cycle leadership, and external stakeholders to optimize reimbursement while ensuring regulatory compliance and documentation integrity.

Primary Duties and Responsibilities : 

1. Supervises, mentors, and evaluates medical coding staff, including hiring, training, performance management, and professional development.
2. Develops and implements coding policies, procedures, and workflows to ensure accuracy, efficiency, and compliance.
3. Establishes and monitors productivity and quality standards for the coding team, conducting regular audits to ensure compliance.
4. Coordinates staffing schedules and workload distribution to meet organizational needs and deadlines.
5. Conducts regular team meetings to communicate updates, address concerns, and foster a collaborative work environment.
6. Serves as subject matter expert for complex coding scenarios across all service lines including medical, dental, behavioral health, and vision.
7. Performs regular internal audits of coded claims to ensure accuracy and identify areas for improvement and additional training.
8. Reviews and resolves coding-related denials, rejections, and appeals in collaboration with revenue cycle staff.
9. Ensures coding practices comply with CPT, ICD-10-CM, HCPCS, and payer-specific coding guidelines.
10. Monitors coding changes and updates from CMS, AMA, and other regulatory bodies, implementing necessary changes promptly.
11. Maintains comprehensive knowledge of Medicare, Medicaid, commercial payer requirements, and HIPAA regulations as they relate to coding and billing.
12. Collaborates with providers and clinical staff to ensure complete and accurate clinical documentation supports appropriate code assignments and addresses staff regarding coding issues and documentation needs.
13. Develops and delivers provider education on documentation requirements and coding guidelines.
14. Participates in compliance audits and responds to external audit requests from payers and regulatory agencies.
15. Ensures all coding activities maintain patient privacy and confidentiality in accordance with HIPAA standards.
16. Prepares and presents regular reports to the Director, Revenue Cycle Management  on coding productivity, quality metrics, denial trends, and revenue impact.
17. Stays current with industry changes and best practices through continuing education and professional development.
18. Collaborates with leadership on revenue cycle improvement initiatives and process optimization projects.
19. Assists in budget preparation and monitors departmental expenses.
20. Evaluates and recommends coding software, tools, and technologies to enhance efficiency and accuracy.
21. Supports Variety Care's accreditation as a Patient Centered Medical Home and commitment to provide care that is Safe, Effective, Patient Centered, Timely, Efficient, and Equitable. Provides leadership to achieve the goals of the "Triple Aim" of healthcare reform—to improve the experience of care, improve health outcomes, and decrease healthcare costs.
22. Embodies the strength of personal character. Places value on being an open and honest communicator who displays high moral and ethical conduct, integrity, adaptability, and sound judgment. Must be a leader in the department and community. Result-oriented problem solver who is responsible and accountable.
23. Performs other duties as assigned.

Requirements, Special Skills or Knowledge :  

1. High school diploma or GED required, associate or bachelor's degree in health information management or related field preferred.
2. Requires a current and active certification in Coding, CPC – Certified Professional coder, or RHIT – Registered Healthcare information technology, or RMC – Registered Medical Coder.  OR at least four years of experience in medical billing and coding.
3. Minimum 7-10 years of medical coding experience required, with demonstrated progression of responsibility.
4. Minimum 3-5 years of supervisory or management experience in a medical coding or revenue cycle environment. Basic knowledge of CPT codes. Experience monitoring coding changes to ensure that the most current information is available. 
5. Proven experience in multi-specialty coding including primary care, behavioral health, and dental preferred.
6. Experience with FQHC (Federally Qualified Health Center) or community health center operations preferred.
7. Mastery of critical thinking, analytics, problem-solving and sound decision-making skills.

Essential Functions :

1. Must be able to lift 25 pounds.
2. Must be able to sit for extended periods of time.
3. Must have excellent concentration ability.