Medical Coding Manager

POSITION SUMMARY: The Medical Coding Manager will be responsible for overseeing the daily operations of the medical coding team, ensuring accurate coding practices related to risk adjustment models Hierarchical Condition Categories (HCC), Current Procedural Terminology (CPT) to ensure compliance with industry standards and regulations. The Medical Coding Manager will play a key role in improving the quality of coding, enhancing risk score accuracy, and optimizing reimbursement processes for the organization.

MISSION: Improving lives, Optimizing wellness, Promoting independence

COMPETENCIES:

• Effective supervision
• Balanced decision making
• Strategic focus
• Manage conflict
• Effective communication
• Facilitate change
• Problem solving
• Quality and compliance focus
• Personal credibility
• Decisiveness

RESPONSIBILITIES AND DUTIES:

Essential Job Functions:

• Team Leadership: Manage, mentor, and lead a team of medical coders, ensuring high-quality, efficient, and accurate coding practices. Provide training and ongoing education on HCC coding, risk adjustment models, and coding updates.
• Coding Oversight: Oversee the accurate assignment of codes for ICD-10, including risk adjustment diagnoses (HCC and CPT), ensuring alignment with both payer and regulatory requirements.
• Risk Score Management: Monitor and track risk scores, identifying opportunities for improvement and ensuring accurate representation of participant acuity to optimize reimbursement.
• Coding Expertise: Serve as the subject matter expert on HCC and CPT coding, providing guidance and support to the coding team regarding complex cases, documentation improvement, and specific coding issues.
• Compliance & Auditing: Ensure compliance with CMS (Centers for Medicare & Medicaid Services) guidelines, as well as federal and state regulations related to medical coding, HCC, CPT and risk adjustment models. Perform regular audits to ensure documentation and coding accuracy. Analyze reports to monitor both favorable and unfavorable trends to address remediation when needed.
• Collaboration: Work closely with clinical teams to ensure accurate coding practices and resolve coding discrepancies. Participate in interdisciplinary team meetings to ensure documentation supports coding and risk score calculations. Provide education to Providers to ensure proper coding practices. Partners with the accounting department to assist with month end process as needed.
• Performance Monitoring: Track team productivity, quality metrics, and coding accuracy, providing regular reports to leadership. Identify areas for improvement and implement performance plans when necessary.
• Continuous Improvement: Stay current with industry trends, coding updates, and regulatory changes to ensure ongoing compliance and efficiency. Promote continuous improvement initiatives related to coding, documentation, and risk score accuracy.
• Other: Additional duties and responsibilities as assigned.

ORGANIZATIONAL (CORE RATING FACTORS):

• Demonstrates support of the Company's Mission, Vision and Core Values
• Provide Exceptional Customer Service.
• Ensure discretion with confidential information in accordance with HIPAA guidelines.
• Support a collaborative work environment including courteous, helpful and professional behavior. 
• Embrace Organizational Excellence through practicing individual time management, efficiency and effectiveness and participating in continuous improvement efforts.
• Adhere to and support all Company policies and procedures.
• Support and practices safe work habits in accordance with policies and procedures.
• Bring ideas, problems and concerns forward and participate in resolution and implementation.
• Participate in and completes regulatory compliance trainings within the prescribed deadlines
• Attends required meetings.
• Maintain skills and knowledge required including written and verbal communication, best practices for industry standards, and computer competency.

SUPERVISORY (JOB SPECIFIC TASKS):

• Exercise job-related judgment and knowledge.
• Organize and prioritize while working with strict deadlines.
• Responsible for the overall supervision of 8 or more positions. including orientation, counseling, training, scheduling, disciplinary actions (with HR assistance).
• Provide guidance and regular coaching to employees.
• Assign tasks fairly and appropriately to job responsibilities.
• Required to maintain detailed supervisory notes documenting counseling and coaching interactions.
• Must address disciplinary issues in a timely manner applying Company policy.
• Ensure that performance evaluations are conducted thoroughly and in a timely manner.
• Communicate goals and expectations clearly and effectively with direct reports.

• Education:
  • Associate's or Bachelor's degree in Health Information Management, Medical Coding, or related field preferred.
  • Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent certification required.
  • Certification in Risk Adjustment (CRC) or HCC coding preferred.
• Experience:
  • Minimum of 5 years of experience in medical coding with at least 3 years in a supervisory or managerial role.
  • Proven expertise in Risk Scores and HCC coding, including in-depth knowledge of risk adjustment models and guidelines.
  • Experience in ICD-10-CM coding and understanding of payer-specific risk adjustment models.
• Skills:
  • Strong understanding of coding and documentation standards.
  • Knowledge of regulatory requirements, including CMS guidelines.
  • Excellent leadership, communication, and interpersonal skills.
  • Detail-oriented with strong analytical and problem-solving abilities.
  • Ability to work collaboratively while managing in-person and telecommuting associates.
• Technical Skills:
  • Proficiency with coding software and Electronic Health Records (EHR) systems.
  • Strong proficiency in Microsoft Office Suite (Excel, Word, PowerPoint).
  • Experience with coding audits, performance tracking, and reporting tools.