About this role
The Revenue Cycle Coding & Auditing Manager provides strategic and day-to-day leadership over coding, coding education and billing compliance/auditing. This role ensures that all billable services are coded timely, accurately, and compliantly; oversees internal and external audit activities; assists with the development of coding/billing education; oversees the function of providing education; optimizes workflows and technology; and partners closely with Clinical Operations, Revenue Cycle and IT to enhance reimbursement, reduce denials, and safeguard compliance with federal/state regulations and payer policies. Job Relationships Reports to the Director of Revenue Integrity Principal Responsibilities
• Lead, develop, and evaluate coding and auditing staff; set performance goals and foster accountability, equity, and continuous improvement. • Oversee daily workflows, work queues, and staffing to meet productivity, quality, and SLA standards. • Manage budgets and forecast staffing/resources to support volume, accuracy, and compliance needs. • Standardize policies, procedures, and controls to ensure consistent, efficient, and compliant operations. • Institute and oversee internal and external coder audits; ensuring a high degree of quality and accuracy of coding • Ensure timely, accurate, and compliant ICD-10-CM/PCS and CPT/HCPCS coding and charge capture. • Partner with providers to improve documentation, medical necessity support, and coding accuracy. • Oversee coding, billing, and documentation audits, including audit plans, sampling, scoring, and corrective actions. • Monitor and optimize claim editing and encoding systems; analyze coding denial and coding edit trends and implement sustainable fixes. • Establish monitoring systems to ensure adherence to Medicare/Medicaid regulations, payer policies, and organizational standards. • Develop and deliver coding and billing education for clinical and non-clinical staff, including new provider onboarding. • Publish guidance and tools that translate regulations into clear, operational workflows. • Analyze coding and medical necessity denials; lead root-cause analysis and implement prevention strategies. • Collaborate with revenue cycle teams to improve first-pass yield, reduce rework, and compliantly enhance reimbursement. • Recommend and implement process and technology improvements to boost clean-claim rates and reduce A/R days. • Monitor KPIs, conduct trend analyses, and present performance and risk updates to leadership. • Serve as a subject matter expert on coding, compliance, and revenue cycle best practices; stay current on regulatory changes. • Lead continuous improvement initiatives to streamline workflows and improve the provider/patient and employee experience. • Ensure timely, professional responses to provider, patient, and payer inquiries related to coding and reimbursement. • Adhere to organizational policies, compliance standards, and safety requirements. • Perform other duties as needed to support departmental and organizational goals. Education/Experience
• Bachelor of Science in Health Information Management degree or equivalent required, master’s degree in business or finance related field preferred.
Licenses/Certificates
• CPC (Certified Professional Coder) Certification required within 1 year of hire. • CCS-P (Certified Coding Specialist-Physician based) Certification required within 2 years of hire. • RHIA (Registered Health Information Administrator) Certification required. Knowledge, Skills and Abilities
• Excellent verbal and written communication; conflict and problem resolution skills • Excellent strategic, analytical and process systems thinking skills • Demonstrated expertise with Teams, Excel, Visio, PowerPoint and other Microsoft Office products • Excellent interpersonal skills, including ability to understand and articulate the needs of stakeholders and assist them in making the decisions necessary to accomplish their objectives • Demonstrated ability in earning and maintaining credibility with leaders across the organization • Ability to respectfully and collaboratively challenge team members to perform within designated timelines Working Environment
• Requires sitting and standing for periods of time working in an office environment. • Use of telephone required. • Some bending and stretching required. PHI/Privacy Level HIPAA1