Coding Manager

Position Summary

The Hospital Coding Manager oversees hospital coding operations and directly supports revenue integrity by ensuring accurate code assignment, compliant documentation interpretation, and timely resolution of coding-related claim denials. This role manages coding quality, productivity, audits, and staff performance while actively participating in the review, correction, and appeal of denials when coding errors, guideline interpretation, or clinical abstraction impact reimbursement. The Coding Manager ensures adherence to regulatory and payer requirements to reduce rework and prevent future denials.

• Coding Operations & Leadership
• Direct, mentor, and evaluate coding staff, ensuring productivity, accuracy, and turnaround time standards are met.
• Assign and prioritize work to manage DNFB, discharged-not-coded, and aging accounts.
• Develop and maintain coding policies, procedures, and workflows aligned with official coding guidelines and payer rules.
• Serve as escalation point for complex or high‑risk coding scenarios.
• Oversee outsourced billing services and validate quality and productivity, as applicable.

• Ensure compliant application of ICD‑10‑CM/PCS, CPT‑4 codes, HCPCS Level II, UHDDS, MS‑DRG/APR‑DRG logic, NCCI edits, modifiers, and POA indicators to the highest level of specificity as supported by documentation in the medical record in compliance with governmental regulations and hospital policies.
• Review the quality of data and documentation and facilitate improvement.
• Responsible for reviewing medical records/assigned charges, as necessary, for accuracy.
• Lead internal coding audits, including focused, random, and targeted reviews.
• Track audit outcomes, identify trends, and implement corrective action plans.
• Maintain coding accuracy standards (typically 95–98%).
• Support regulatory, payer, and compliance initiatives.

• Independently review and work coding‑related denials, including DRG downgrades, medical necessity, modifier usage, diagnosis sequencing, and bundling issues.
• Correct coding errors, rebill claims, and provide detailed rationale for appeal submissions.
• Collaborate with Patient Financial Services, Billing, and Revenue Integrity to resolve claim issues and reduce recurrence.
• Analyze denial trends, quantify financial impact, and implement prevention strategies.
• Provide coding subject‑matter expertise for appeals, payer discussions, and escalation reviews.

• Develop ongoing coder education programs based on audit and denial findings.
• Deliver targeted remediation and performance improvement coaching.
• Communicate annual ICD‑10, CPT®, HCPCS, CMS, and payer updates.
• Ensure staff maintain credentials and required continuing education.

• Manage coding workflows within EHRs and encoder/groupers (Cerner, 3M).
• Monitor dashboards for productivity, accuracy, DNFB, denials, and rework.
• Generate reports to support leadership, compliance, and revenue cycle initiatives.
• Recommend system edits or workflow improvements to reduce denial risk.

• Education:
  
  Medical Coding and Billing Certificate (Accredited Program)
• Certifications:
  
  CCS required (RHIT, RHIA, or CPC acceptable with hospital coding experience).
• Experience:
• Minimum 5 years of hospital coding experience (inpatient and outpatient).
• At least 2 years in a supervisory, management or leadership role.
• Demonstrated experience working coding‑related denials and supporting appeals.

Proficiency with hospital EHRs, encoder/groupers, audit tools, and Excel‑based reporting.

• Strong understanding of payer denial logic, medical necessity, coverage determinations, and appeal processes.
• Advanced knowledge of DRG methodology, SOI/ROM, and reimbursement impacts.
• Experience with billing platforms or Revenue Cycle management tools such as Billing Rev 360 is a plus.
• Ability to interpret payer correspondence and translate findings into operational improvements.
• Excellent written and verbal communication skills.
• Strong computer skills with knowledge of Microsoft Outlook, Word, Excel and 3M.
• Ability to work with detail.

• Coding accuracy =95–98%
• Coding turnaround time and DNFB within targets
• Decrease in coding‑related denials and rework
• Timely resolution of appealed and corrected claims
• Audit improvement and education effectiveness

• Full‑time position; standard business hours with flexibility for deadlines and payer timelines.
• On‑site position.
• Prolonged computer work required.