Manager

Roles & Responsibilities:

• Lead and manage a team of medical coding specialists, ensuring accurate and timely auditing of multi-specialty claims. 
• Provide coaching, training, and mentorship to enhance team performance and foster a collaborative work environment. 
• Oversee coding workflows, assign priorities, and ensure productivity, quality, and turnaround time targets are consistently achieved. 
• Stay current with coding guideline updates, payer policies, regulatory changes, and industry best practices, and communicate relevant updates to the team. 
• Conduct regular coding audits and quality reviews to ensure compliance with coding standards, documentation requirements, and organizational policies. 
• Collaborate with cross-functional teams, including Analytics, Quality, and Compliance, to optimize coding operations and resolve coding-related issues. 
• Monitor and analyze key performance indicators (KPIs), identify performance gaps, and implement continuous improvement initiatives. 
• Apply payment integrity principles to identify coding inaccuracies, documentation deficiencies, billing errors, and revenue optimization opportunities. 
• Serve as the subject matter expert (SME) for multi-specialty surgical coding and payment integrity, providing guidance to internal stakeholders and supporting accurate documentation and coding practices. 
• Ensure compliance with healthcare regulations, including HIPAA, HITECH, CMS, Medicare, and commercial payer requirements. 

Performs clinical review of cases received from the specialist team or other departments within CCR, determines if additional clinical information if required, makes a clinical decision to approve or deny a case based on plan coverage, criteria and / or guidelines or pend / refer it to the Regional Medical Directors for further review for medical necessity, and coordinates a peer to peer (doctor to doctor case discussion) review as applicable.

Bachelor Degree in relevant field with 6- 8 years of relevant experience