Manager, Professional Medical Coding & Quality Assurance

Cape Cod Healthcare Inc; Hyannis (MA); On-site; USD 100,000 - 120,000; Full time

Job summary

Cape Cod Healthcare in Hyannis, MA seeks a Manager of Professional Medical Coding to lead the professional coding function and staff, ensure compliance, and drive quality improvement in documentation and reimbursement.

The role emphasizes auditing, training, and collaboration with physicians, practice managers, and leadership to enhance clinical documentation and coding accuracy. Full-time, base salary ranges with benefits as part of the Cape Cod Healthcare package.

Qualifications

• Bachelor’s degree required or equivalent combination of education and experience.
• 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 auditing and/or management.
• 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.

Responsibilities

• Ensure compliant coding operations quality coding and abstraction of clinical data in accordance 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.
• 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.
• 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.

Skills

Auditing experience

Management

Leadership

Education

Bachelor’s degree

Master’s degree preferred

Job description

Cape Cod Healthcare in Hyannis, MA seeks a Manager of Professional Medical Coding to lead the professional coding function and staff, ensure compliance, and drive quality improvement in documentation and reimbursement.

The role emphasizes auditing, training, and collaboration with physicians, practice managers, and leadership to enhance clinical documentation and coding accuracy. Full-time, base salary ranges with benefits as part of the Cape Cod Healthcare package.