Manager, Coding and Auditing
Springfield Clinic · Springfield
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
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