Manager Professional Billing Coding Operations - Remote
$78,000–$113,000 year
RemoteUnited States
Job Summary
Manage the Professional Billing Coding Operations team by supervising staff, establishing staffing schedules, and assigning workloads. Conduct quality assurance reviews of inpatient and outpatient records to validate code selection, perform random chart audits, and initiate queries for incomplete documentation. Review coding denials to resolve issues, identify trends, and provide feedback to providers and departments. Provide in-service training and mentorship to coders on ICD-10-CM, CPT-4, and HCPCS guidelines, while enforcing compliance with Official Coding Rules and Regulations. Support external coding reviews such as RAC audits and track coding accountabilities from internal and external sources.
Required Qualifications
- Bachelor's degree or equivalent combination of formal education and experience
- CPC – Certified Professional Coder
- At least five years of experience in coding
- Experience must include education/mentoring/training
- Minimum of five years acute care hospital experience coding with ICD-10-CM and CPT-4
- Academic medical setting or trauma center preferred
- Minimum of three years management experience
- Five years preferred
- Prior experience working claim edits and denials
- Excellent command of the ICD-10-CM and CPT4/HCPCS coding conventions
- E&M coding
- Concepts of human anatomy, physiology and pathology
- Strong knowledge of health records, computerized billing and charging systems
- Microsoft applications
- Data integrity
- Processing techniques
- Ability to multi-task
- Prioritize essential tasks
- Follow-through
- Meet timelines
- Work with accuracy and attention to detail
- Ability to solve problems appropriately using job knowledge and current policies/procedures
- Ability to work cooperatively with members of the healthcare delivery team and staff
- Ability to handle frequent interruptions
- Adapt to changes in workload and work schedule
- Respond quickly to urgent requests
- Ability to maintain strict confidentiality of all personal/health sensitive information
- Ensure compliance of HIPAA rules and regulations
- Extensive knowledge of hospital inpatient and outpatient reimbursement methodologies
- In-depth knowledge of medical terminology
- ICD-10-CM and CPT-4 Coding conventions (including E&M coding)
- CMS National Coverage Determinations
- Various other applicable coding regulations and law
- Must possess extensive knowledge of payer claim edits and payer denials
Desired Qualifications
- Academic medical setting or trauma center preferred
- Minimum of five years acute care hospital experience coding with ICD-10-CM and CPT-4
- Five years preferred
- Prior experience working claim edits and denials
- Excellent command of the ICD-10-CM and CPT4/HCPCS coding conventions
- E&M coding
- Concepts of human anatomy, physiology and pathology
- Strong knowledge of health records, computerized billing and charging systems
- Microsoft applications
- Data integrity
- Processing techniques
- Ability to multi-task
- Prioritize essential tasks
- Follow-through
- Meet timelines
- Work with accuracy and attention to detail
- Ability to solve problems appropriately using job knowledge and current policies/procedures
- Ability to work cooperatively with members of the healthcare delivery team and staff
- Ability to handle frequent interruptions
- Adapt to changes in workload and work schedule
- Respond quickly to urgent requests
- Ability to maintain strict confidentiality of all personal/health sensitive information
- Ensure compliance of HIPAA rules and regulations
- Extensive knowledge of hospital inpatient and outpatient reimbursement methodologies
- In-depth knowledge of medical terminology
- ICD-10-CM and CPT-4 Coding conventions (including E&M coding)
- CMS National Coverage Determinations
- Various other applicable coding regulations and law
- Must possess extensive knowledge of payer claim edits and payer denials
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