Manager, Revenue Cycle and Auditing

Springfield Clinic•Springfield, IL

6h•Onsite

About The Position

The Revenue Cycle Coding & Auditing Manager provides strategic and day-to-day leadership over coding, coding education and billing compliance/auditing. This role ensures that all billable services are coded timely, accurately, and compliantly; oversees internal and external audit activities; assists with the development of coding/billing education; oversees the function of providing education; optimizes workflows and technology; and partners closely with Clinical Operations, Revenue Cycle and IT to enhance reimbursement, reduce denials, and safeguard compliance with federal/state regulations and payer policies.

Requirements

Bachelor of Science in Health Information Management degree or equivalent required
CPC (Certified Professional Coder) Certification required within 1 year of hire.
CCS-P (Certified Coding Specialist-Physician based) Certification required within 2 years of hire.
RHIA (Registered Health Information Administrator) Certification required.
Excellent verbal and written communication; conflict and problem resolution skills
Excellent strategic, analytical and process systems thinking skills
Demonstrated expertise with Teams, Excel, Visio, PowerPoint and other Microsoft Office products
Excellent interpersonal skills, including ability to understand and articulate the needs of stakeholders and assist them in making the decisions necessary to accomplish their objectives
Demonstrated ability in earning and maintaining credibility with leaders across the organization
Ability to respectfully and collaboratively challenge team members to perform within designated timelines

Nice To Haves

master’s degree in business or finance related field preferred.

Responsibilities

Lead, develop, and evaluate coding and auditing staff; set performance goals and foster accountability, equity, and continuous improvement.
Oversee daily workflows, work queues, and staffing to meet productivity, quality, and SLA standards.
Manage budgets and forecast staffing/resources to support volume, accuracy, and compliance needs.
Standardize policies, procedures, and controls to ensure consistent, efficient, and compliant operations.
Institute and oversee internal and external coder audits; ensuring a high degree of quality and accuracy of coding
Ensure timely, accurate, and compliant ICD-10-CM/PCS and CPT/HCPCS coding and charge capture.
Partner with providers to improve documentation, medical necessity support, and coding accuracy.
Oversee coding, billing, and documentation audits, including audit plans, sampling, scoring, and corrective actions.
Monitor and optimize claim editing and encoding systems; analyze coding denial and coding edit trends and implement sustainable fixes.
Establish monitoring systems to ensure adherence to Medicare/Medicaid regulations, payer policies, and organizational standards.
Develop and deliver coding and billing education for clinical and non-clinical staff, including new provider onboarding.
Publish guidance and tools that translate regulations into clear, operational workflows.
Analyze coding and medical necessity denials; lead root-cause analysis and implement prevention strategies.
Collaborate with revenue cycle teams to improve first-pass yield, reduce rework, and compliantly enhance reimbursement.
Recommend and implement process and technology improvements to boost clean-claim rates and reduce A/R days.
Monitor KPIs, conduct trend analyses, and present performance and risk updates to leadership.
Serve as a subject matter expert on coding, compliance, and revenue cycle best practices; stay current on regulatory changes.
Lead continuous improvement initiatives to streamline workflows and improve the provider/patient and employee experience.
Ensure timely, professional responses to provider, patient, and payer inquiries related to coding and reimbursement.
Adhere to organizational policies, compliance standards, and safety requirements.
Perform other duties as needed to support departmental and organizational goals.