Manager, Clinical & Coding Review
$107,700–$199,300 year
RemoteMissouri, United States or Florida, United States
Job Summary
Lead strategic leadership for teams performing advanced, complex claim reviews to ensure accuracy, regulatory compliance, and payment integrity. Analyze performance trends, standardize processes, and implement consistent review methodologies while leveraging expertise in ICD-10, CPT/HCPCS coding, and clinical guidelines to drive operational strategies. Direct team operations by assigning priorities, setting goals, and coordinating daily activities, while fostering a high-performance culture focused on continuous improvement and professional development. Monitor and optimize business processes, establish end-to-end audit program lifecycles, and collaborate with cross-functional stakeholders to identify process improvement opportunities. Maintain transparent communication through regular one-on-one and team meetings, ensuring full compliance with all regulatory, contractual, and organizational requirements.
Required Qualifications
- Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future
- Associate's Degree in health information management, Nursing, or a related field
- 5+ years Managerial/Supervisory experience
- 8+ years Complex medical claim review experience
- 3+ years DRG review experience
- Clinical Documentation Improvement experience
- Proficiency ICD-10-CM/PCS, MS-DRG, APR-DRG
- Proficiency Readmission, APC, EAPG, and other review types
- RHIA - Registered Health Information Administrator
- RHIT - Registered Health Information Technician
- CCS-Certified Coding Specialist
- Clinical Inpatient Coder (CIC)
- Certified Clinical Documentation Specialist (CCDS)
- CDIP - Clinical Documentation Improvement Professional
- RN - Registered Nurse - State Licensure and/or Compact State Licensure in combination with a coding credential
- Must be able to travel up to 25%
Desired Qualifications
- CDIP - Clinical Documentation Improvement Professional
- RN - Registered Nurse - State Licensure and/or Compact State Licensure in combination with a coding credential
Hiring someone like this?
Get your role in front of qualified candidates on Sorce.