Manager, Revenue Cycle and Auditing

Springfield Clinic; Springfield (IL); Presencial; USD 90.000 - 150.000; Jornada completa

Descripción de la vacante

Springfield Clinic is seeking a Revenue Cycle Coding & Auditing Manager to provide strategic and day-to-day leadership over coding, education, and billing compliance. You will oversee audits, improve documentation, and partner with Clinical Operations, Revenue Cycle and IT to enhance reimbursement and reduce denials.

Responsibilities include leading staff, standardizing policies, monitoring KPIs, delivering education, and staying current with regulations.

Formación

• Bachelor of Science in Health Information Management or equivalent required; master’s degree preferred.
• CPC certification required within 1 year of hire; CCS-P certification required within 2 years; RHIA certification required.
• Excellent verbal and written communication; strategic, analytical and process systems thinking skills.

Responsabilidades

• 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/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 a high degree of quality and accuracy of coding
• 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 coding edit trends and implement sustainable fixes.
• Establish monitoring systems to ensure adherence to Medicare/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.

Conocimientos

Communication

Strategic thinking

Analytical skills

Microsoft Office

Educación

Bachelor of Science in Health Information Management

Master's degree in business or finance related field

Herramientas

Teams

Excel

Visio

PowerPoint

Descripción del empleo

The Revenue Cycle Coding & Auditing Manager provides strategic and day-to-day leadership over coding, coding education and billing compliance/auditing. This role ensures that all billable services are coded timely, accurately, and compliantly; oversees internal and external audit activities; assists with the development of coding/billing education; oversees the function of providing education; optimizes workflows and technology; and partners closely with Clinical Operations, Revenue Cycle and IT to enhance reimbursement, reduce denials, and safeguard compliance with federal/state regulations and payer policies.

Job Relationships

Reports to the Director of Revenue Integrity

Principal 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/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 a high degree of quality and accuracy of coding
• 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 coding edit trends and implement sustainable fixes.
• Establish monitoring systems to ensure adherence to Medicare/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.

Education/Experience

• Bachelor of Science in Health Information Management degree or equivalent required, master’s degree in business or finance related field preferred.

Licenses/Certificates

• 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.

Knowledge, Skills And Abilities

• Excellent verbal and written communication; conflict 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 ability to understand and articulate the needs of stakeholders and assist them in making the decisions necessary to accomplish their objectives
• Demonstrated ability in earning and maintaining credibility with leaders across the organization
• Ability to respectfully and collaboratively challenge team members to perform within designated timelines

Working Environment

• Requires sitting and standing for periods of time working in an office environment.
• Use of telephone required.
• Some bending and stretching required.

PHI/Privacy Level

HIPAA1