CODING AND REVENUE INTEGRITY MANAGER

Horizon Health•Paris, IL

just now•$69,903 - $111,844

About The Position

The Manager of Coding & Revenue Integrity is responsible for the performance, accuracy, and compliance of hospital and professional coding, charge capture processes, and chargemaster (CDM) governance across the organization. This role provides operational leadership for hospital-based (HB) and professional-based (PB) coding functions, ensuring accurate code assignment, timely coding completion, and compliance with all regulatory and payer requirements. The Manager oversees revenue integrity activities, including charge capture processes and chargemaster (CDM) governance, supporting accurate reimbursement across all organizational service lines and reimbursement methodologies, including Critical Access Hospital (CAH), Rural Health Clinic (RHC), Emergency Medical Services (EMS), hospital-based (HB), professional-based (PB), and other provider-based services as applicable. Working in a Critical Access Hospital (CAH) environment, this role plays a critical part in optimizing reimbursement, reducing denials, and preventing revenue leakage. The Manager partners closely with clinical departments, Patient Access, and Revenue Cycle leadership to improve documentation, coding accuracy, and charge capture workflows, driving measurable improvements in financial performance and compliance.

Requirements

Associate’s degree required
Relevant coding certifications required (e.g., RHIT, RHIA, CCS, CPC)
5+ years of experience in hospital and/or professional coding, revenue integrity, or charge capture
2–3 years of leadership or supervisory experience required
Experience in hospital-based (HB) and professional-based (PB) coding required
Demonstrated experience improving coding accuracy, reducing denials, or enhancing charge capture processes
Comprehensive knowledge of ICD-10-CM/PCS, CPT, and HCPCS coding guidelines
Strong understanding of Medicare, Medicaid, commercial payer requirements, and reimbursement methodologies impacting hospital, professional, CAH, RHC, EMS, and provider-based services
Familiarity with NCCI edits, medical necessity requirements, LCD/NCD guidance, and government reimbursement regulations
Knowledge of chargemaster (CDM) structure, maintenance, and pricing alignment
Understanding of revenue integrity principles, including charge capture, documentation alignment, and compliance requirements
Familiarity with audit processes, coding compliance, and regulatory standards.
Experience working with EHR systems, coding tools, encoder software, and billing systems
Ability to analyze coding, denial, and charge capture data to identify trends and improvement opportunities
Proficiency in reporting tools and data analysis (Excel or equivalent)
Strong operational leadership skills with the ability to manage coding workflows and revenue integrity processes
Demonstrated ability to lead, develop, and mentor coding and revenue integrity staff
Excellent communication skills, with the ability to collaborate with clinical, financial, and operational stakeholders
Ability to drive process improvement, standardization, and accountability across departments.
High level of integrity, accuracy, and attention to detail

Nice To Haves

Bachelor’s degree in Health Information Management, Healthcare Administration, or related field preferred
Experience supporting diverse reimbursement methodologies, including Critical Access Hospital (CAH), Rural Health Clinic (RHC), Emergency Medical Services (EMS), and other provider-based services preferred

Responsibilities

Oversee coding operations supporting multiple care settings and reimbursement methodologies, including CAH, RHC, EMS, hospital-based, professional-based, and other provider-based services as applicable
Monitor coding productivity, accuracy, and turnaround times, implementing improvements as needed
Ensure coding practices align with regulatory requirements, payer guidelines, and organizational policies
Oversee charge capture processes across departments to ensure services provided are accurately documented and billed
Identify and resolve charge capture issues, including missing charges, incorrect coding, and workflow gaps
Collaborate with clinical departments to improve documentation practices that support accurate coding, charge capture, and reimbursement
Maintain and oversee the hospital chargemaster, ensuring accuracy, completeness, and compliance with regulatory requirements
Coordinate implementation of annual regulatory coding updates, CPT/HCPCS changes, and reimbursement modifications impacting the chargemaster
Review and update CDM entries, including CPT/HCPCS codes, revenue codes, and pricing alignment
Partner with Finance and Revenue Cycle leadership on CDM strategy and maintenance processes
Support coding and revenue integrity processes across CAH, RHC, EMS, and other specialized reimbursement methodologies
Monitor regulatory and payer changes impacting coding and reimbursement and coordinate operational implementation
Partner with Revenue Cycle leadership to address reimbursement risks associated with specialized billing programs
Analyze coding and charge-related denials to identify root causes and implement corrective actions
Partner with Revenue Cycle teams to reduce denials and improve clean claim rates
Support initiatives to improve reimbursement accuracy and reduce revenue leakage
Conduct coding and charge capture audits to ensure compliance and identify improvement opportunities
Provide education and training to coding staff, clinical departments, and other stakeholders
Coordinate internal and external coding audit activities and monitor corrective action plans to ensure sustained compliance
Ensure audit readiness and compliance with all applicable regulatory requirements
Monitor and report key performance metrics, including coding accuracy, productivity, denial trends, and charge capture performance
Use data to identify trends, risks, and opportunities for improvement
Provide regular reporting to Revenue Cycle leadership
Recruit, train, and develop coding and revenue integrity staff
Establish performance expectations and accountability measures
Provide coaching, feedback, and ongoing development to staff
Evaluate and improve coding and charge capture workflows to enhance efficiency and accuracy
Develop and maintain standardized coding, documentation, charge capture, and revenue integrity policies and procedures
Implement best practices for coding, documentation, and revenue integrity processes
Partner with providers, clinical departments, Patient Access, Finance, and the Central Business Office to improve documentation quality, reduce reimbursement risk, and strengthen end-to-end revenue cycle performance.