Medical Coding Manager

CareWell Health; East Orange (NJ); Hybrid; USD 80,000 - 90,000; Full time

Benefits offered by this job

Health, Dental and Vision Insurance

401(k)

Paid Holidays and PTO

Job summary

CareWell Health is seeking an experienced Medical Coding Manager to ensure accurate, timely coding across inpatient, outpatient, ED, and other cases. You will oversee production, quality, and consistency of coding by internal and external teams, review documentation, and collaborate with physicians and payers.

The role requires strong knowledge of ICD-10, CPT-4, HCPCS, and DRGs; leadership, audit experience, and proficiency with Excel.

Qualifications

• Bachelor’s degree in health information systems or related field.
• CCS certification required.
• One of CCS, CPC, RHIT or RHIA required.
• Minimum five years medical office/hospital coding experience; supervisory preferred.
• Strong knowledge of ICD-10, CPT-4, HCPCS and DRGs.
• Advanced knowledge of medical terminology, anatomy and physiology.
• Proficiency with Excel and MS Office; report generation ability.

Responsibilities

• Oversee high-quality, timely coding for inpatient and outpatient accounts using ICD-10, CPT-4 and HCPCS.
• Ensure accuracy and consistency across DNFB related to Coding.
• Review coding queries and provide guidance to staff as needed.
• Develop and implement policies affecting operations and organizational impact.
• Lead day-to-day coding operations including analytics, dashboards and reports.
• Provide mentoring and education to coders; manage performance and development.
• Collaborate with physicians, insurers and other stakeholders to resolve issues.
• Perform QA audits on coders and maintain productivity benchmarks.

Skills

ICD-10

CPT-4

HCPCS

DRGs

Medical terminology

Auditing

Excel

Leadership

Education

Bachelor’s degree in health information systems

CCS certification

CPC / RHIT / RHIA certification options

Tools

Electronic coding systems

Microsoft Office

Job description

Job Summary

At Carewell Health, we rely on powerfully insightful data to ensure the delivery of excellent healthcare services, and we are seeking an experienced medical coding Manager to deliver this insight daily. The ideal candidate will have thorough knowledge of anatomical and medical terminology, as well as natural curiosity and an analytical mindset. As the coding Manager oversees production, quality, and consistency of the inpatient/outpatient/ED/SDS and other cases coded by the internal and external coding teams. mines and interprets patient medical records, transcriptions, test results, and other documentation; we will rely on them to ask questions, connect the dots, and uncover information that may be difficult to find — all to ensure a smooth billing process. The medical coding manager will abide by standard protocols of the profession while using their own methods to compile the most accurate information and promote organizational growth.

Essential Functions

• Manage high-quality, timely coding of diagnoses and procedures for inpatient and outpatient accounts, using ICD-10, CPT-4, and HCPCS classification systems.
• Strong knowledge of DRG's.
• Reviews coding queries, when necessary, to determine if impactful.
• Exceptional knowledge of ICD, CPT, and HCPS coding guidelines. Advanced knowledge of medical terminology, anatomy, and physiology.
• Work closely with physicians, technicians, insurance companies, and other integral parties to uncover and discuss coding analysis results.
• Manages the DNFB as it relates to Coding.
• Corrects coding related edits, issues and questions that come from the Revenue Cycle Department.
• Develop and execute policies and procedures that affect immediate operations and may also have organization-wide impact
• Analyze issues in which the situation or data requires in-depth knowledge of organizational objectives
• Implement strategic policies by selecting methods and evaluation criteria for accurate results
• Responsible for day-to-day coding operations, productivity, quality, data analytics, dashboards and reports, education, employee management and development, and clients within a specific client group or geography of clients.
• Perform Quality Assurance Audits on Coders.
• Maintains productivity benchmarks, assists in the development of productivity benchmarks.
• Is responsible for weekly productivity log management, tracking, trending, and dashboard creation.
• Provide feedback and mentoring as needed to achieve productivity standards.
• Prioritizes, schedules, assigns, and monitors work to optimize operational services.
• Strong organizational skills and oral and written communication skills.
• Advanced computer skills including the use of Microsoft office products, especially Excel, electronic mail, including experience with electronic coding systems and applications.
• Possess strong organizational skills and attention to detail.
• Ability to multi-task and meet multiple deadlines.
• Audits inpatient and outpatient cases on a consistent basis to ensure continued quality.
• Consistently reviews coded cases for accuracy.

Other Duties

• Gather physician background information from various resources for reporting purposes
• Analyze medical malpractice claims by identifying issues, events, diagnoses, and procedures that led to result
• Prepare summaries and assign the appropriate codes
• Review claims to formulate a synopsis of facts, and collaborate with claims examiners as needed
• Make corrections to draft reports after physician review and submit approved reports to managers in a timely fashion.
• Codes cases as needed.
• Provides Education and ongoing training for medical coders. Interact with claims staff, attorneys, physicians, and many other hospital related stakeholders regarding reports.
• Performs related duties, as required.

Minimum Education/Certifications

• Bachelor’s degree (or equivalent) in health information systems or related field
• Must have the following certification: Certified Coding Specialist (CCS).
• Must have one of the following certifications: Certified Coding Specialist (CCS), Certified Professional Coder (CPC), Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA)

Minimum Work Experience

Experience: Minimum five years medical office hospital experience in coding preferred required. Management or lead experience preferred. Some auditing experience preferred.

Position Type/Expected Hours of Work:

8AM-4PM, 40 hours per week. Hybrid.

Physical Demands Analysis

Long periods of sitting may be required. Repetitive motion of wrists required. Lifting requirements are minimal to none. Corrected vision and hearing to normal range is required.

CareWell Health provides a salary/hourly rate range for all open positions to comply with New Jersey Law. The rates listed for each position is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining a team member’s base salary and/or rate, several factors may be considered as applicable (e.g., specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity). The salary range does not include bonuses/incentives, differential pay or other forms of compensation which can be discussed in detail with your talent acquisition specialist.

The salary/hourly rate range for this position is:$80,000-$90,000

Salary ranges shown on third-party job sites may not accurately reflect ranges provided by CareWell Health. Candidates should discuss salary/hourly compensation and details of our comprehensive benefits with our talent acquisition specialist if selected for an interview.

We offer an excellent benefit package including but not limited to the following benefit offerings:

• Health, Dental and Vision Insurance
• Basic Life and Disability Insurance
• Whole Life, Accident, Critical Illness and Hospital Indemnity Insurance
• Flexible Spending Accounts
• Employee Assistance Program
• 401(k)
• Paid Holidays and a generous Paid Time Off Plan