Coding Audit Manager

Review and analyze coding denials, including CPT, ICD-10-CM, and HCPCS-related denials, to identify root causes and coding-related trends.

Identify recurring denial patterns and implement corrective actions to reduce future denials and improve coding accuracy.

Collaborate with billing, revenue cycle, and clinical teams to research and resolve coding discrepancies and denial issues.

Conduct audits of medical records to ensure coding accuracy, documentation support, and compliance with regulatory and payer requirements.

Develop and maintain regular reporting on coding-related denials, including denial volumes, denial reasons, financial impact, trends, and resolution outcomes.

Summarize findings from coding denial reviews and communicate key issues, trends, and opportunities for improvement to leadership and operational teams.

Track recurring coding errors and identify opportunities for coder education, provider education, workflow improvements, or process changes.

Monitor the effectiveness of corrective actions and provide follow-up reporting to ensure identified issues are resolved.

Develop and maintain a coding denial crosswalk by payer to identify common denial reasons, payer-specific coding requirements, and applicable CPT, ICD-10-CM, and HCPCS coding issues.

Document payer-specific denial patterns and requirements to support consistent denial resolution and prevention strategies.

Use the denial crosswalk to identify trends across payers and prioritize education, audits, and corrective actions.

Partner with internal teams to ensure the crosswalk remains current as payer policies, edits, and denial trends evolve.

Monitor coding productivity and quality metrics to identify performance trends, opportunities for improvement, and potential workflow barriers.

Analyze coder productivity in conjunction with denial and quality findings to identify opportunities for education, process improvement, and workload optimization.

Develop and maintain productivity reporting to track individual and team performance against established goals and benchmarks.

Identify trends impacting productivity, including workflow inefficiencies, system issues, documentation challenges, and payer-specific requirements.

Provide feedback and recommendations to leadership regarding productivity performance, staffing needs, workflow improvements, and operational efficiencies.

Prepare and submit comprehensive appeal letters with supporting documentation.

Ensure appeals are submitted within payer-specific timeframes.

Track and document the status of appeals until resolution.

Maintain up-to-date knowledge of coding guidelines, payer policies, and regulatory requirements.

Ensure all coding and billing activities comply with HIPAA and other relevant regulations.

Document all denial and appeal activities accurately in the system.

Generate reports on denial trends and appeal outcomes for management review.

Communicate effectively with internal departments and external payers to resolve issues.

Provide feedback, training, and best practices for coding staff based on findings from denials.

Perform other related duties as assigned.

Preferred: RHIA, CDI, CPC, CCS, CCS-P.

Bachelor’s degree or equivalent is required.

Minimum of 6 years of experience in medical coding and billing, with a focus on denial management.

Prior experience supervising or leading a team.

Familiarity with various payer guidelines, including Medicare and Medicaid.

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