Revenue Cycle Coding & Auditing Manager
About The Position
The Revenue Cycle Coding & Auditing Manager provides strategic and day-to-day leadership over coding, coding education, and billing compliance and auditing. The role ensures billable services are coded timely, accurately, and compliantly; oversees internal and external audits; supports the development and delivery of coding and billing education; optimizes workflows and technology; and partners with Clinical Operations, Revenue Cycle, and IT to enhance reimbursement, reduce denials, and safeguard compliance with regulations and payer policies. The manager leads coding and auditing staff and operations, oversees coding and documentation quality, supports provider documentation improvement, monitors regulatory and payer compliance, and uses performance and denial trends to guide corrective actions and process improvements. The position reports to the Director of Revenue Integrity.
Requirements
- Bachelor of Science in Health Information Management 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 resolution, 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 the ability to understand and articulate stakeholder needs and help stakeholders make decisions necessary to accomplish their objectives.
- Demonstrated ability to earn and maintain 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 a 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 and 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 high coding quality and accuracy.
- 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 edit trends and implement sustainable fixes.
- Establish monitoring systems to ensure adherence to Medicare and 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.
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What This Job Offers
Job Type
Full-time
Career Level
Manager
