Manager

Roles & Responsibilities:

• Lead and manage a team of medical coding specialists, ensuring accurate and timely auditing of multi-specialty claims.
• Provide coaching, training, and mentorship to enhance team performance and foster a collaborative work environment.
• Oversee coding workflows, assign priorities, and ensure productivity, quality, and turnaround time targets are consistently achieved.
• Stay current with coding guideline updates, payer policies, regulatory changes, and industry best practices, and communicate relevant updates to the team.
• Conduct regular coding audits and quality reviews to ensure compliance with coding standards, documentation requirements, and organizational policies.
• Collaborate with cross-functional teams, including Analytics, Quality, and Compliance, to optimize coding operations and resolve coding-related issues.
• Monitor and analyze key performance indicators (KPIs), identify performance gaps, and implement continuous improvement initiatives.
• Apply payment integrity principles to identify coding inaccuracies, documentation deficiencies, billing errors, and revenue optimization opportunities.
• Serve as the subject matter expert (SME) for multi-specialty surgical coding and payment integrity, providing guidance to internal stakeholders and supporting accurate documentation and coding practices.
• Ensure compliance with healthcare regulations, including HIPAA, HITECH, CMS, Medicare, and commercial payer requirements.

Qualifications

Bachelor Degree in relevant field with 6- 8 years of relevant experience

Responsibilities

Performs clinical review of cases received from the specialist team or other departments within CCR, determines if additional clinical information if required, makes a clinical decision to approve or deny a case based on plan coverage, criteria and / or guidelines or pend / refer it to the Regional Medical Directors for further review for medical necessity, and coordinates a peer to peer (doctor to doctor case discussion) review as applicable.