Revenue Cycle Coding & Auditing Manager

Stratum Med; Springfield (IL); On-site; USD 110,000 - 140,000; Full time

Job summary

Stratum Med is seeking a Revenue Cycle Coding & Auditing Manager to provide strategic and day-to-day leadership over coding, education, and billing compliance. The role oversees audits, education, and optimizes workflows to enhance reimbursement.

You will collaborate with Clinical Operations, Revenue Cycle and IT to safeguard compliance with federal/state regulations and payer policies. Reports to the Director of Revenue Integrity.

Qualifications

• Bachelor of Science in Health Information Management required.
• CPC, CCS-P, RHIA certifications required within the specified timelines.
• Strong leadership and collaboration skills with proven ability to drive change.

Responsibilities

• Lead coding and auditing staff; set goals and drive continuous improvement.
• Oversee daily workflows, 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 for efficient operations.
• Institute and oversee coder audits; ensure high 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 and medical necessity support.
• Oversee coding, billing, and documentation audits, including plans, sampling, scoring and corrective actions.
• Monitor claim editing and encoding systems; analyze denial trends and implement fixes.
• Establish monitoring to adhere to Medicare/Medicaid regulations and payer policies.
• Develop and deliver coding and billing education for staff, including onboarding.
• Publish guidance translating regulations into operational workflows.
• Analyze denials; lead root-cause analyses and prevention strategies.
• Collaborate with revenue cycle teams to improve first-pass yield and reduce denials.
• Recommend process and technology improvements to boost clean-claim rates and reduce A/R days.
• Monitor KPIs and present performance updates to leadership.
• Serve as SME on coding, compliance, and revenue cycle best practices.

Skills

Verbal & written communication

Strategic thinking

Analytical skills

Microsoft Office

Education

Bachelor of Science in Health Information Management

Master's degree in business or finance (preferred)

Tools

Auditing tools

Billing systems

Job description

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