Coding Manager, Coding PB

Coding Manager, Professional Fee Medical Coding

The Coding Manager oversees the provider-based medical coding team ensuring all professional services are coded with the highest level of accuracy, compliance and efficiency while supporting the company clients.

This role serves as a subject matter expert and client-facing leader responsible for evaluating professional fee medical coding and related revenue cycle operations, identifying performance opportunities, developing recommendations, and leading implementation initiatives that improve coding accuracy, billing performance, reimbursement, compliance, quality, and financial outcomes.

This position requires a strong understanding of provider-based coding methodologies,  revenue cycle operations, payer requirements, reimbursement, analytics, and operational performance.

Key Responsibilities

• Supervises day-to-day coding operations for professional fee claims across multiple clinical specialties.

•

Monitor workflow and ensure compliance with standard operating procedures (SOPs).

• Steps in for hands-on support on complex coding reviews and escalated coding issues from the customer and coders.

• Monitor program performance and develop corrective action and improvement plans.

• Identify opportunities to improve coding accuracy, reimbursement, productivity, quality, and financial performance.

• Provide subject matter expertise in professional fee coding and billing.

• Evaluate coding and billing workflows and identify operational gaps.

• Review coding accuracy, productivity, quality, reimbursement, and compliance trends.

• Evaluate the relationship between documentation, coding, billing, reimbursement, and denials.

• Identify opportunities to reduce coding-related denials and prevent revenue leakage.

• Evaluate charge capture, claim submission, edits, billing workflows, and payer requirements.

• Partner with CDI, coding, utilization review, denials, and revenue cycle teams to improve overall financial performance.

• Maintain knowledge of ICD-10-CM/PCS, CPT, HCPCS, modifiers, edits, medical necessity, and applicable payer requirements.

Client Leadership

• Serves as a client-facing leader for professional fee coding operations.

• Lead coder and client meetings.

• Develop recommendations based on client data, workflows, financial performance, and operational findings.

• Establish strong relationships with coding leaders, providers and other stakeholders.

• Manage client escalations and ensure timely resolution.

• Identify opportunities to expand existing client relationships through additional solutions.

• Evaluate the impact of coding, CDI, billing, denials, utilization, and payer behavior on reimbursement.

• Identify revenue leakage and opportunities for improved reimbursement.

• Support initiatives designed to improve clean claim rates, reduce denials, accelerate reimbursement, and improve net revenue.

• Partner with clients to establish appropriate benchmarks and improvement targets.

Analytics & Reporting

• Develop and interpret dashboards and performance reports.

• Establish program baselines and measurable improvement targets.

• Analyze productivity, quality, denial, reimbursement, and financial metrics.

• Partner with the company analytics resources to develop meaningful client reporting.

• Participate in implementation of new coding, billing, and revenue cycle programs.

Quality, Compliance & Audit

• Ensure coding and billing programs comply with applicable federal and state regulations, payer requirements, and client policies.

• Monitor coding quality and compliance.

• Support internal and external audits.

• Identify compliance risks and recommend corrective action.

• Ensure appropriate documentation and audit trails are maintained.

• Establish clear performance expectations and accountability.

•

Promote a culture of quality, accountability, continuous improvement, and client service.

Qualifications Required

• Bachelor’s degree in health information management, Healthcare Administration, Business, Finance, or related field; equivalent experience may be considered.

• 7+ years of progressive experience in professional fee coding, billing, HIM, revenue cycle, or healthcare financial operations. Must be credentialed coder with a minimum of one of these certifications:   RHIA, RHIT, CPC, CCS, or CCS-P.

• 2+ years of leadership or supervisory experience.

• Strong understanding of professional fee billing and revenue cycle operations.

• Experience working with healthcare clients, hospitals, health systems, or physician organizations.

• Strong understanding of payer requirements and reimbursement methodologies.

• Excellent written, verbal, presentation, and communication skills.

• Experience with Epic or other major EHR platforms.

• Experience with encoder, CAC, CDI, billing, or revenue cycle technology.

• Experience with hospital denials and appeals.

• Experience with revenue integrity.

• Experience working with outsourced coding or revenue cycle organizations.

• Experience managing multi-client or national healthcare programs.

• Travel as needed.