Coding And Revenue Integrity Manager

Coding And Revenue Integrity Manager

Horizon Health is a Critical Access, Rural Health Facility comprised of 25-inpatient beds located in Paris, IL & a multitude of outpatient clinic settings including Family Practice and Specialty Clinics in Paris and surrounding cities. We have been serving residents of Edgar County since 1968 though community education, emergency services, and outpatient care. As we continue to expand our services & locations, our community has grown far beyond Paris.

Our rich history and strong community support pave the way for the future of healthcare as we serve you—our family, friends, and neighbors.

The Manager of Coding & Revenue Integrity is responsible for the performance, accuracy, and compliance of hospital and professional coding, charge capture processes, and charge master (CDM) governance across the organization.

This role provides operational leadership for hospital-based (HB) and professional-based (PB) coding functions, ensuring accurate code assignment, timely coding completion, and compliance with all regulatory and payer requirements. The Manager oversees revenue integrity activities, including charge capture processes and charge master (CDM) governance, supporting accurate reimbursement across all organizational service lines and reimbursement methodologies, including Critical Access Hospital (CAH), Rural Health Clinic (RHC), Emergency Medical Services (EMS), hospital-based (HB), professional-based (PB), and other provider-based services as applicable.

Working in a Critical Access Hospital (CAH) environment, this role plays a critical part in optimizing reimbursement, reducing denials, and preventing revenue leakage. The Manager partners closely with clinical departments, Patient Access, and Revenue Cycle leadership to improve documentation, coding accuracy, and charge capture workflows, driving measurable improvements in financial performance and compliance.

Essential Functions (Responsibilities/Accountabilities):

Coding Operations (HB & PB)

• Oversee coding operations supporting multiple care settings and reimbursement methodologies, including CAH, RHC, EMS, hospital-based, professional-based, and other provider-based services as applicable
• Monitor coding productivity, accuracy, and turnaround times, implementing improvements as needed
• Ensure coding practices align with regulatory requirements, payer guidelines, and organizational policies

Revenue Integrity & Charge Capture

• Oversee charge capture processes across departments to ensure services provided are accurately documented and billed
• Identify and resolve charge capture issues, including missing charges, incorrect coding, and workflow gaps
• Collaborate with clinical departments to improve documentation practices that support accurate coding, charge capture, and reimbursement

Chargemaster (CDM) Governance

• Maintain and oversee the hospital charge master, ensuring accuracy, completeness, and compliance with regulatory requirements
• Coordinate implementation of annual regulatory coding updates, CPT/HCPCS changes, and reimbursement modifications impacting the charge master
• Review and update CDM entries, including CPT/HCPCS codes, revenue codes, and pricing alignment
• Partner with Finance and Revenue Cycle leadership on CDM strategy and maintenance processes

Government Reimbursement & Specialized Billing Support

• Support coding and revenue integrity processes across CAH, RHC, EMS, and other specialized reimbursement methodologies
• Monitor regulatory and payer changes impacting coding and reimbursement and coordinate operational implementation
• Partner with Revenue Cycle leadership to address reimbursement risks associated with specialized billing programs

Denials Prevention & Revenue Optimization

• Analyze coding and charge-related denials to identify root causes and implement corrective actions
• Partner with Revenue Cycle teams to reduce denials and improve clean claim rates
• Support initiatives to improve reimbursement accuracy and reduce revenue leakage

Auditing, Compliance & Education

• Conduct coding and charge capture audits to ensure compliance and identify improvement opportunities
• Provide education and training to coding staff,…