Manager, Professional Medical Coding

Cape Cod Healthcare; Hyannis (MA); On-site; USD 95,000 - 125,000; Full time

Job summary

Cape Cod Healthcare in Hyannis, MA seeks an experienced Manager to lead the professional coding team, ensuring compliance and quality across coding operations. You will supervise staff, coordinate with practices and vendors, and drive improvements in documentation and reimbursement processes.

The role requires strong auditing skills, regulatory knowledge, and the ability to guide education initiatives for clinicians and coders.

Qualifications

• Bachelor's degree required or equivalent combination of education and experience.
• CCS (AHIMA) or CPC (AAPC) certification required.
• Minimum of five years of progressive experience in professional coding including auditing and/or management.
• Strong working knowledge of medical terminology, anatomy and physiology, and reimbursement requirements.

Responsibilities

• Manage professional coding staff and vendors; facilitate issue resolution.
• Oversee daily operations of the Physician Coding Department.
• Monitor DNFB and other KPIs; implement action plans when goals aren’t met.
• Develop physician education strategies to promote complete and accurate documentation.
• Collaborate with physicians, practice managers and leadership to improve documentation quality.

Skills

Auditing

Management

Coding quality

Communication

Regulatory understanding

Education

Bachelor's degree

CCS (AHIMA)

CPC (AAPC)

Tools

EPIC

Job description

Purpose of Position

Manages professional coding function and corresponding staff. Manages auditing and quality control and improvement initiatives, ensures compliance with internal policies and procedures and governing agencies, and works with HIM/Coding Director to assist with departmental needs and planning.

Description

• Ensure compliant coding operations quality coding and abstraction of clinical data in accordance with compliance with established policies, regulations, procedures and standards.
• Manages staff performance as related to coding, communication with practices and resolution of claim edits, denials, procedures and standards as related to Physician Coding.
• Manage Professional coding staff and vendors performing professional coding and facilitates problem resolution of coding issues
• Work with the Professional PFS dept to facilitate resolution of coding/billing issues, monitoring, reviewing, and resolve denial issues.
• Monitor discharged not final billed daily accounts receivable and accounts (“DNFB”) and any other metrics/benchmarks established by the department to achieve established fiscal goals for the department. Consistently monitors all EPIC work queues.
• Confirm the supervisory staff is consistently maintaining performance, and monitoring processes.
• Define, implement, and monitor strategies for improving documentation.
• Develop physician education strategies in conjunction with validation team and MACC leadership to promote complete and accurate clinical documentation.
• Develop and report performance measures to the medical staff and other departments of physician specific information regarding documentation compliance.
• Collaborate extensively with physicians, practice managers, MACC leadership, nursing staff and other patient caregivers to improve quality and completeness of documentation of care provided and coded.
• Oversees the daily operations of the Physician Coding Department
• Administers education and training necessary, evaluating the effectiveness of the education plan or performance improvement plans, providing feedback to Director.
• Work collaboratively with HIM/Coding Management and Practice Management staff to assess the strengths of practitioners and staff involved in the coding process and make recommendations for improvements.
• Serve as a resource to physician practices and staff for ongoing educational needs related to coding. Respond to practitioners and management questions regarding coding and reimbursement, researching as necessary to find answers and make recommendations.
• Assist in the development, implement and evaluate educational programs for Coding applications and processes.
• Provides input to Coding Management for employee evaluations.
• Develop and administer Quality Improvement (QI) and compliance initiatives, including internal and external coding quality audits.
• Manage to applicable coding Key Performance Indicators (“KPIs”). Define and implement action plans when performance is not meeting expectations.
• Assess direct reports’ performance on a consistent basis and provide feedback to reward effective performance and enable proactive performance improvement steps to be taken.
• 19. Ensure coding employees and vendor staff are performing coding functions in a manner which complies with established policies, processes and Compliance programs.
• Support IT in their efforts to test modifications and troubleshoot issues for the EPIC system and any systems that feed into it.
• Maintains current working knowledge of all coding and reimbursement rules, regulations, trends and new developments. Responsible for providing knowledge to staff as related.
• Makes sound judgments; strong organizational, independent, problem solving and analytical skills.
• Consistently provides service excellence to all patients, family members, visitors, volunteers and co-workers.
• Challenges current working practices; identifies process improvement opportunities and presents recommendations and solutions to management. Engages and commits to the organization’s culture of continuous improvement by actively participating, supporting, and promoting CCHC Pillars of Excellence.
• Performs other job related duties and assignments as requested.

Qualifications

• Bachelor’s degree required or equivalent combination of education and experience. Master’s degree preferred.
• Current CCS (AHIMA Certified Coding Specialist) or CPC (AAPC Certified Professional Coder) required.
• Minimum of five years of previous progressive experience in multiple specialties of Professional Coding including experience in auditing and/or management.
• Possess strong working knowledge of medical terminology, anatomy and physiology, reimbursement requirements.
• One to two years supervisory experience of professional coding staff.
• Requires comprehensive understanding of Evaluation and Management Coding and Specialty coding.
• Strong knowledge of fiscal intermediary and regulatory agency regulations for coding and provider reimbursement.
• Specialty in E&M (CEMC), Certified Evaluation and Management Coder through the AAPC, or CPMA, Certified Professional Medical Auditor through the AAPC preferred.
• An understanding of the psychology of complex corporate relationships, and an ability to influence within such an environment.
• Demonstrated ability to use PC based office productivity tools (e.g. Microsoft Office) is required.
• Demonstrated goal-oriented thinking, operational and organizational skills.
• Demonstrated ability to create training materials and deliver training in area of expertise including large group presentations.
• Ability to communicate with and present to a wide variety of CCHC and external users, including senior management and physicians, as well as outside vendors and consultants.
• Ability to work under pressure and manage multiple initiatives concurrently; must be able to work independently, set own priorities and meet deadlines.

Schedule Details

Full-Time, Monday-Friday, No Weekends and No Holidays

Organization : Cape Cod Healthcare, Inc.

Primary Location : Massachusetts-Hyannis

Department : HCI-PB Health Info Mgmt

Annual/Hourly: Unassigned

Hiring Pay Range: 0 - 0