The Manager, HIM Coding Auditing and Education provides leadership and operational oversight for the inpatient and outpatient coding audit and education programs. This position is responsible for ensuring coding accuracy, regulatory compliance, and continuous improvement in coding quality across the organization.
Requirements
- Manage IP & OP Coding Audit Programs & Team
- Provide leadership and oversight of inpatient and outpatient coding audit programs and staff
- Direct the review and analysis of internal and external audit findings
- Develop, implement, and maintain coding audit strategies
- Provide leadership in staff education, coaching, and performance management for coding auditors and coding staff
- Collaborate with Coding Leadership, CDI, Compliance, Revenue Integrity, and Patient Financial Services leadership
- Participate in recruitment, hiring, onboarding, and training of coding auditors
- Oversee preparation of executive-level audit reports and present findings and recommendations
- Coordinate with Compliance leadership to review and respond to internal and external audit results
- Provide strategic oversight of inpatient and outpatient coding education programs
- Direct the development and maintenance of coding orientation and training programs
- Oversee development of education materials based on audit findings and regulatory updates
- Ensure effective onboarding and competency development of coding staff and monitor training progress
- Partner with Coding leadership to support performance improvement initiatives and quality remediation plans
- Serve as a subject matter expert on official coding guidelines and regulatory requirements
- Direct and oversee delivery of individual and group coding education sessions
- Monitor changes to coding methodologies, official coding guidelines, regulatory requirements, and reimbursement methodologies
- Oversee analysis of coding and clinical documentation impacts on reimbursement and identify improvement opportunities
- Provide leadership and oversight of the Coding Editor program and staff
- Direct denial prevention strategies and workflows related to coding edits and medical necessity requirements
- Ensure Coding Editor processes comply with regulatory requirements and official coding guidelines
- Oversee resolution of complex coding-related edits and denial prevention activities
- Direct coding-related denial prevention and reimbursement recovery efforts
- Collaborate with Patient Financial Services (PFS), HIM Coding Support, and CDI leadership to resolve medical necessity provider documentation issues
- Review and triage PFS-related, coding-related, and clinical-related denials and DRG downgrades
- Manage and resolve coding-related inpatient and outpatient claim denials, rejections, and DRG downgrades
- Prepare, develop comprehensive rebuttal letters and appeal packages, submit, and track first- and second-level coding-related appeals
- Maintain advanced knowledge of legal, regulatory, and policy requirements related to coding and documentation
- Direct regulatory and coding research activities using authoritative resources
- Ensure coding audit and education activities comply with federal and state regulations and payer policies
- Provide coding expertise to support audit defense and payer dispute resolution
- Lead root cause analysis activities to identify systemic coding, documentation, and workflow issues
- Direct analysis of denial trends, DRG downgrades, and audit findings
- Develop and implement corrective action plans in collaboration with Coding, CDI, Billing, and clinical leadership
- Support documentation improvement initiatives in collaboration with CDI leadership
- Oversee development and maintenance of reports to monitor audit activity, denial trends, appeal outcomes, and coding accuracy
- Direct data analysis to support performance improvement, education, and revenue cycle optimization initiatives
- Provide actionable recommendations to leadership to improve coding accuracy and reduce denials
- Serve as a primary liaison between Coding, CDI, Compliance, Revenue Integrity, Patient Financial Services, clinical departments and external payers
- Communicate coding audit findings, compliance risks, and improvement opportunities to leadership and stakeholders
- Maintain effective working relationships with internal and external stakeholders
- Ensure clear and timely communication regarding coding issues and regulatory changes
- Provide oversight of coding audit and education systems and tools
- Ensure effective use of coding and electronic health record systems
Benefits
- Generous Paid Time Off
- 401k Matching
- Retirement Plan
- Health Insurance
- Dental Insurance
- Vision Insurance
- Life Insurance
- Disability Insurance
- Flexible Spending Account
- Employee Assistance Program
- Paid Holidays
- Vacation Time
- Sick Leave
- Relocation Assistance
