MANAGER, CODING OPERATIONS-Coding Integrity

Duke University Health System; Durham (NC); On-site; USD 110,000 - 150,000; Full time

Job summary

Duke Health is seeking a senior leader for the Patient Revenue Management Organization to oversee the Coding Operation departments and drive excellence in coding and billing across hospital and professional services.

The role requires extensive expertise in ICD-10-CM/PCS/CPT, payer regulations, and strong management skills to guide audits, policy development, and cross-functional coordination. On-site work is expected in Durham, NC, with collaboration across the health system.

Qualifications

• Extensive knowledge of ICD-10-CM, PCS and CPT coding guidelines.
• Deep understanding of hospital, technical and professional service reimbursements.
• Strong leadership, communication and analytical abilities.
• Requires experience supervising coding activities in healthcare.

Responsibilities

• Oversee all functions within the Coding Operation departments.
• Coordinate audits, training and policy development for coding/billing.
• Ensure timely operations, QA, and department integration.
• Lead cross-functional collaboration with directors and managers.
• Interpret LCD, NCD and payer regulations for service coverage.
• Recruit, hire, and evaluate coding staff; manage workflows.

Skills

ICD-10-CM/PCS/CPT knowledge

Reimbursement systems (DRGs, APCs, RBR

Leadership and management

Communication skills

Interpersonal skills

Education

BS Health Information Management

MBA or Health Administration

Job description

At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together.

Patient Revenue Management Organization

Pursue your passion for caring with the Patient Revenue Management Organization, which is the fully integrated, centralized revenue cycle organization that supports the entire health system in streamlining the revenue cycle. This includes scheduling, registration, coding, billing, and other essential revenue functions for Duke Health.

General Job Description

Responsible for the oversight of all functions within the Coding Operation departments, including but not limited to providing support at the division level for daily departmental operations, reimbursement opportunities, and various programs. Serve as a member of the team; subscribe to the vision, values and expectations of the Duke University Health System.

Job Duties

Duties

• 20% - Oversee Quality/Focused Audits for all PRMO Coding teams- PB and HB
• 5% - Act as contact and coordinator for organization auditing needs
• 5% - Identify areas for improvement and recommend solutions where education is needed for accurate coding and billing for both Hospital and Professional areas.
• 20% - Provide direction for department; Ensure TAT are met, QC of auditor QA, Ensure departmental integration, develop operational policies, procedures, standards and expectations, provide clear opportunities to meet or exceed objectives
• 5% - Assist with policy and procedure maintenance for coding and auditing functions
• 10% - Read and interpret LCD, NCD and other payer regulations and guidelines as related to coverage of services
• 10% - Interviewing, hiring, training employees, planning, assigning, and directing workflows, employee performance evaluation, proactively manage production and quality controls, resolving problems.
• 20% - Collaborate with other managers to ensure consistent implementation of coding policies, procedures and practice; maintain strong communications with director and peer managers
• 5% - Any/All other duties assigned by director

Knowledge, Skills And Abilities

Extensive knowledge of ICD-10-CM, PCS and CPT coding principal and guidelines. Extensive knowledge of hospital/technical and professional services reimbursement systems (DRGs, APCs, RBRVUs). Extensive knowledge of Federal, State and payer specific regulations and policies pertaining to documentation, coding, billing for technical and professional services, strong managerial leadership, and interpersonal skills. Excellent written and oral communication skills, excellent analytical skills.

Education Requirements / Preferences

BS Health Information Management, Health Informatics, Health Administration, Finance or related field. Master’s degree in Business Administration or Health Administration is preferred

Experience Requirements / Preferences

Six years of experience in the healthcare industry is required, two of the six years are supervising or coordinating coding activities.

Licensure / Certification Requirements

Registered Health Information Administrator (RHIA), or Registered Health Information Technician (RHIT). Certified Coding Specialist (CCS) or Certified Professional Coder (CPC) is a bonus.

Financial Responsibilities

• Develop budget recommendations
• Prepare budget requests and written narratives
• Review expenses against budget

Supervisory Responsibilities

Duties

% of Time

Compliance Specialist 6

Working Conditions

Mark all that apply

• Must be able to work under time pressures in a busy virtual office environment
• Must be present on site for 8 hour shifts during standard business hours
• Must participate in group activities requiring interpersonal skills and cooperation
• Must work as later person when scheduled or according to business need
• Must be able to react quickly and immediately respond to emergencies
• Must travel between locations on a needed basis
• Must be able to handle multiple assignments, conflicting demands and priorities
• Must maintain attention to detail over extended period of time
• Must be continually aware of variations in changing situations
• Must be able to move throughout office environment throughout the day
• Must be able to lift XX lbs.
• Must be able to push/pull XX lbs.
• Must be able to carry XX lbs.
• Must be able to reach for objects by extending arms

Duke is an Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex (including pregnancy and pregnancy related conditions), sexual orientation or military status.

Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas—an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.

Essential Physical Job Functions

Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.