Coding Manager, Coding PB

HURC•Short Hills, NJ

About The Position

The Coding Manager oversees the provider-based medical coding team, ensuring professional services are coded accurately, compliantly, and efficiently while supporting HURC clients. The role is a subject matter expert and client-facing leader who evaluates professional fee coding and related revenue cycle operations, identifies performance opportunities, develops recommendations, and leads initiatives to improve coding accuracy, billing performance, reimbursement, compliance, quality, and financial outcomes. The position requires a strong understanding of provider-based coding methodologies, revenue cycle operations, payer requirements, reimbursement, analytics, and operational performance. The manager supervises coding operations across multiple clinical specialties, supports complex and escalated coding reviews, monitors performance, and leads corrective actions and continuous improvement. As a client-facing leader, the manager works with clients and internal teams to evaluate coding, billing, documentation, charge capture, claims, denials, payer behavior, and financial performance. The role also develops and interprets performance reporting, establishes baselines and measurable targets, supports program implementations, and helps ensure coding and billing programs meet applicable regulations, payer requirements, and client policies. Travel is required as needed.

Requirements

Bachelor’s degree in health information management, healthcare administration, business, finance, or a related field; equivalent experience may be considered.
At least 7 years of progressive experience in professional fee coding, billing, HIM, revenue cycle, or healthcare financial operations.
Must hold at least one of the following coder certifications: RHIA, RHIT, CPC, CCS, or CCS-P.
At least 2 years of leadership or supervisory experience.
Strong understanding of professional fee billing and revenue cycle operations.
Experience working with healthcare clients, hospitals, health systems, or physician organizations.
Strong understanding of payer requirements and reimbursement methodologies.
Excellent written, verbal, presentation, and communication skills.
Travel as needed.

Nice To Haves

Experience with Epic or other major EHR platforms.
Experience with encoder, CAC, CDI, billing, or revenue cycle technology.
Experience with hospital denials and appeals.
Experience with revenue integrity.
Experience working with outsourced coding or revenue cycle organizations.
Experience managing multi-client or national healthcare programs.

Responsibilities

Supervise day-to-day professional fee coding operations across multiple clinical specialties.
Monitor workflows and ensure compliance with standard operating procedures.
Provide hands-on support for complex coding reviews and escalated issues from clients and coders.
Monitor program performance and develop corrective action and improvement plans.
Identify opportunities to improve coding accuracy, reimbursement, productivity, quality, and financial performance.
Provide subject matter expertise in professional fee coding and billing.
Evaluate coding and billing workflows and identify operational gaps.
Review coding accuracy, productivity, quality, reimbursement, and compliance trends.
Evaluate the relationship between documentation, coding, billing, reimbursement, and denials.
Identify opportunities to reduce coding-related denials and prevent revenue leakage.
Evaluate charge capture, claim submission, edits, billing workflows, and payer requirements.
Partner with CDI, coding, utilization review, denials, and revenue cycle teams to improve financial performance.
Maintain knowledge of ICD-10-CM/PCS, CPT, HCPCS, modifiers, edits, medical necessity, and applicable payer requirements.
Lead coder and client meetings and serve as a client-facing leader for professional fee coding operations.
Develop recommendations based on client data, workflows, financial performance, and operational findings.
Build relationships with coding leaders, providers, and other stakeholders.
Manage client escalations and ensure timely resolution.
Identify opportunities to expand existing client relationships through additional solutions.
Evaluate how coding, CDI, billing, denials, utilization, and payer behavior affect reimbursement.
Identify revenue leakage and opportunities for improved reimbursement.
Support initiatives to improve clean claim rates, reduce denials, accelerate reimbursement, and improve net revenue.
Partner with clients to establish appropriate benchmarks and improvement targets.
Develop and interpret dashboards and performance reports.
Establish program baselines and measurable improvement targets.
Analyze productivity, quality, denial, reimbursement, and financial metrics.
Partner with HURC analytics resources to develop meaningful client reporting.
Participate in implementation of new coding, billing, and revenue cycle programs.
Ensure coding and billing programs comply with applicable federal and state regulations, payer requirements, and client policies.
Monitor coding quality and compliance and support internal and external audits.
Identify compliance risks and recommend corrective action.
Ensure appropriate documentation and audit trails are maintained.
Establish clear performance expectations and accountability.
Promote a culture of quality, accountability, continuous improvement, and client service.