The Manager of Coding Integrity will provide leadership and strategic guidance in managing and improving coding practices, with a particular focus on developing and maintaining coding policies, quality assurance, training programs, and client communication. This role will oversee a comprehensive Coding and Reimbursement Policy program, ensure coding audits and quality are tracked and improved, and drive educational initiatives to ensure accurate and compliant coding. Additionally, the Manager will lead initiatives to enhance coding processes and compliance activities that directly improve revenue, client satisfaction, and overall performance.

Coding and Reimbursement Policy Program:

• Develop and maintain expert-level knowledge of all professional component physician coding policies for services rendered in acute care environments, including multi-specialty health services, office, inpatient, outpatient, emergency, urgent care, nursing facility, and other settings providing evaluation and management services.
• Lead efforts to improve client revenue by analyzing and enhancing existing coding policies in a compliant manner, aligning coding practices with industry standards and regulatory requirements.

Coding Quality Assurance Program:

• Oversee the tracking and reporting of coding audit activities, ensuring accurate monthly reports on audit scores and productivity are delivered to Senior Management.
• Lead the Coding Quality Improvement team to manage and maintain a robust coding quality assurance program that ensures all coding processes are carefully reviewed for accuracy, with clear tracking of coder performance and quality metrics.
• Identify opportunities to reduce costs, improve efficiency, and enhance the overall accuracy of the company’s coding output, resulting in improved revenue and client service.
• Strengthen compliance activities by ensuring accurate reporting to the Compliance department on coding inconsistencies and any issues that may compromise claim integrity and reimbursement.
• Plan, direct, and maintain a coding policy reference source that consolidates and codifies all company coding policies for reference and consistency.

Coder Training Program:

• Lead the Coding Training team to ensure new hires are thoroughly and accurately trained in a timely and cost-effective manner, ensuring they meet coding production requirements.
• Assess new hires’ knowledge, experience, and adaptability to identify the best candidates and ensure they fit with the company’s standards and expectations.
• Regularly assess the effectiveness of the coding training program, track training statistics, and report trends to Senior Management, taking necessary actions to improve training processes as needed.

Policy and Issue Resolution:

• Respond to policy-related questions and issues from clients, coders, and Accounts Receivable (A/R) staff in a timely and professional manner, ensuring resolution and clarity.

Collaboration with Other Teams:

• Support Quality Improvement leadership, Provider Compliance leadership, the Practice Improvement team, and Reimbursement Coding leadership with coder education and in-service training on topics related to coding compliance and improvements.

Departmental and Company Communication:

• Attend all departmental and company meetings to provide updates and ensure alignment across teams on coding-related issues and initiatives.
• Communicate any deviations or variations from established workflows promptly to direct reports, ensuring clear communication on expectations and corrective actions.

Claims Adjudication and Issue Resolution:

• Handle or escalate any issues that may prevent timely daily claims adjudication, ensuring claims are processed within the organization's established timeframes.

Regulatory Compliance and Coding Guidelines:

• Ensure all coding practices align with industry standards, including but not limited to, the Center for Medicare/Medicaid Services (CMS), Health Care Financing Administration (HCFA), ICD-10 Coding Manual, American Hospital Association’s Coding Clinic, American Medical Association’s CPT book, and the organization's internal coding guidelines

Knowledge, Skills, & Abilities

• Strong written and verbal communication skills; a persuasive and passionate communicator with excellent interpersonal and multidisciplinary project skills
• Action-oriented, adaptable, and innovative approach to business planning
• Strong knowledge of coding guidelines
• Ability to work effectively in collaboration with diverse groups of people
• Passion, idealism, integrity, positive attitude, mission-driven, and self-directed

Education & Experience Requirements

Education: Bachelor’s degree in Healthcare Administration, Health Information Management, or a related field preferred.

Certifications: Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent coding certification required.

Experience:

• At least 5 years of experience in medical coding or a related field, with at least 2 years in a leadership or managerial role.
• Demonstrated expertise in coding policy development, quality assurance, and coder training.
• Proven ability to lead teams to improve coding accuracy, efficiency, and client outcomes.

Skills & Competencies:

• In-depth knowledge of coding systems (ICD-10, CPT, HCPCS) and healthcare reimbursement.
• Strong leadership and team management skills, with the ability to mentor and guide staff.
• Exceptional problem-solving and analytical skills to improve coding processes and revenue outcomes.
• Excellent communication skills, both written and verbal, with the ability to manage complex client and internal relationships.
• Proficiency in MS Office Suite and coding software.
• Strong organizational skills and the ability to manage multiple priorities in a fast-paced environment

Supervisory Responsibilities:

Responsible for supervision of Coding Quality Improvement Auditors. Ability to manage more than 10 employees in a remote environment across multiple time zones.