Manager - Professional Clinical Coding

MaineHealth; Scarborough (ME); Remote; USD 83,000 - 113,000; Full time

Benefits offered by this job

Paid parental leave

Flexible work options

Student loan assistance

Professional development opportunities

Well-being resources

Job summary

MaineHealth is seeking a Revenue Integrity Manager to lead the Clinical Data Section for Provider Based outpatient claims, coding, abstraction, and data analysis. The role supports licensure, billing, and reimbursement processes while ensuring regulatory compliance.

The position requires leadership in a hospital revenue cycle, experience with EPIC and CDI tools, and a strong background in medical terminology, coding guidelines, and payer policies. Fully remote option noted.

Qualifications

• Advanced education with strong communication and statistical skills.
• Certification in RHIA/RHIT/CCS or CPC required.
• At least 2 years of supervisory experience.
• Experience with EPIC, claim edit processes, encoder software and CDI programs.
• Knowledge of medical records, billing, and Provider Based payment systems.

Responsibilities

• Direct concurrent and retrospective coding reviews and physician education.
• Oversee coding accuracy and compliance with Federal, State and Joint Commission requirements.

Skills

Leadership

Communication

Coaching

Statistics

Regulatory compliance

Education

Health Information Management degree

Associate/Bachelor degree in Health Records

Tools

EPIC

Encoder software

CDI programs

Grouper

Severity of Illness Systems

Job description

Summary

This position manages Revenue Integrities Clinical Data Section, which is accountable for: coding and abstracting the medical records of Provider Based practice outpatient practice clinic claims i; preparing statistical analysis of medical records data; compiling, analyzing and summarizing data from medical records into various formats. The output of this Section is used for: meeting hospital licensure requirements; financial and billing purposes, which includes the identification and determination of appropriate reimbursement under inpatient and outpatient prospective payment systems; maintenance of acceptable accounts/receivables and Pre A/R levels; compliance with internal and external regulatory agencies, such as Quality Improvement Organizations, the Centers for Medicare & Medicaid Services, and The Joint Commission.

Description

MaineHealth Corporate (100% remote)

Management/Leadership

Req #: 83189

Summary

This position manages Revenue Integrities Clinical Data Section, which is accountable for: coding and abstracting the medical records of Provider Based practice outpatient practice clinic claims i; preparing statistical analysis of medical records data; compiling, analyzing and summarizing data from medical records into various formats. The output of this Section is used for: meeting hospital licensure requirements; financial and billing purposes, which includes the identification and determination of appropriate reimbursement under inpatient and outpatient prospective payment systems; maintenance of acceptable accounts/receivables and Pre A/R levels; compliance with internal and external regulatory agencies, such as Quality Improvement Organizations, the Centers for Medicare & Medicaid Services, and The Joint Commission.

Required Minimum Knowledge, Skills, And Abilities (KSAs)

• Education: Advanced education which should include communication and mathematical/statistical skills and/or extensive knowledge in organization, research and analysis normally acquired through the completion of Health Record Administration/ Technician /Science Bachelor's/Associate Degree program, preferred.
• License/Certifications: Certification in one of the follow areas required: RHIA/RHIT, CCS, CPC. Skilled in ICD10 diagnosis and CPT coding and knowledge of Provider Based Billing practices.
• Experience: A minimum of two years prior successful supervisory experience required; Experience with EPIC, claim edit processes, encoder software and CDI programs, preferred.
• Full working knowledge of: medical information and revenue cycle systems; Grouper and Severity of Illness Systems; medical record systems, medical terminology, anatomy, physiology, pathophysiology, microbiology, and pharmacology; State, Federal and Joint Commission requirements pertaining to medical records; Provider Based payment systems, preferred.
• Demonstrated abilities to: correctly interpret and apply Federal regulations and PRO requirements in the interpretation of various billing guidelines (i.e., medical necessity, resident supervision policies, correct coding initiative, etc. Ability to direct concurrent and retrospective coding reviews and provide physician education, required
• Effective skills in leadership, communications, coaching, planning, motivation, and establishing effective working relationships with at all levels of staffing in the organization.

Additional Information

• MaineHealth is committed to fostering a supportive, inclusive environment where care team members can thrive while making a meaningful impact in the communities we serve across Maine and New Hampshire. We offer competitive benefits including paid parental leave, flexible work options, student loan assistance, professional development opportunities, and well-being resources—so you can grow your career while feeling supported both personally and professionally.
• We recognize the value each team member brings to our organization. Any offer of employment will depend on qualifications such as skills, relevant experience, education, certifications, and other job-related factors. The base range is an estimate and does not reflect the full value of our total compensation package.
• The pay range for this position is $83,324.80to $112,736.00per year.
• Compensation for part-time positions isdeterminedon a prorated basis consistent with the scheduled hours and applicable full-time equivalent (FTE).
• In addition to base pay, MaineHealth offerscomprehensivebenefits, recognition programs, career growth opportunities, and,where applicable,shiftdifferentials or other incentives.

Notice Regarding Maine Employer Surveillance Statute

Pursuant to Maine's Employer Surveillance Statute, prospective care team members are notified that MaineHealth may monitor, collect, record, review, or retain information related to the use of its systems, networks, applications, files, data, communications platforms (including notified recordings), smart badges, building access, company vehicle GPS data, business calls, and workplace security cameras.

Information collected may be used for legitimate business purposes, including security, safety, compliance, investigations, training, quality assurance, and operational management.