Pb Coding Manager

The Physician Coding Manageroverse the daily operations of a medical coding department, ensuring that professional services provided by physicians are accurately translated into standardized codes for billing and compliance. Performs other related duties as necessary.

• Departmental Oversight: Manage the daily workflow of the physician coding department. Oversee accurate assignment of CPT, HCPCS, and ICD-10-CM codes for physician services.

• Centers for Medicare & Medicaid Services (CMS) regulations
• Office of Inspector General (OIG) guidelines
• American Medical Association (AMA) CPT guidance
• Monitor adherence to payer-specific policies (Medicare, Medicaid, commercial plans).
• Prevent and address upcoding, downcoding, and unbundling risks.

• Track KPIs such as:
  • Coding accuracy rate
  • DNFB (Discharged Not Final Billed) impact
  • Denial rates related to coding
  • Productivity benchmarks
• Generate dashboards for executive leadership.
• Identify financial risk areas related to coding.

• Educate physicians and APPs on:
  • E/M documentation requirements
  • Medical necessity
  • Modifier usage
  • Split/shared visits
  • Incident-to billing
• Provide specialty-specific education sessions.
• Support new provider onboarding regarding documentation standards.

• Develop and manage internal coding audit programs.
• Conduct routine and focused audits (E/M leveling, modifier usage, procedural coding).
• Track accuracy rates and implement corrective action plans.
• Coordinate external audits (RAC, MAC, commercial payer reviews).
• Present audit findings to executive leadership and providers.

• Partner with Revenue Cycle, CDI, Compliance, and Finance teams.
• Monitor coding-related denials and implement denial prevention strategies.
• Ensure timely charge capture and reconciliation processes.
• Analyze reimbursement trends and coding impact on revenue.

• Education: A
  Bachelor’s degree
  in Health Information Management, Health Services Administration, or a related field is typically required or preferred.
• Experience: Generally requires3-5 years
  of physician coding experience, with at least2–3 years
  in a leadership or supervisory role (preferred).
• Certifications: Professional certification from AAPC or AHIMA is essential (or at least working towards). Common credentials include:
  • CPC (Certified Professional Coder)
  • CCS-P (Certified Coding Specialist – Physician-based)
  • RHIT (Registered Health Information Technician) or
    RHIA
    (Registered Health Information Administrator)