Medical Coding Manager
hace 15 días
Clifton
Job Description Coding Manager – Vascular Surgery Position Overview We are seeking a highly analytical, solutions-oriented Coding Manager with a strong background in vascular surgery coding, proven people-management skills, and the ability to improve processes that drive coding quality, operational efficiency, and revenue performance. The Coding Manager will lead the professional coding team for a high-volume, multi-specialty vascular surgery practice encompassing hospital-based procedures, ambulatory surgery centers (ASCs), office-based laboratories (OBLs), office visits, imaging, and other vascular services. This position combines technical coding expertise with hands-on operational leadership. The Coding Manager will be responsible for managing and developing the coding team, establishing performance standards, identifying and resolving operational problems, conducting coding audits, improving provider documentation, and implementing initiatives that improve charge capture and reimbursement while maintaining strict compliance with applicable coding and billing requirements. A key responsibility will be to establish proactive processes that identify coding and documentation opportunities before claims are submitted, including pre-billing reviews, targeted audits, provider education, and systematic analysis of missed charges, undercoding, documentation deficiencies, and recurring errors. The successful candidate will be a strong problem solver who can independently analyze issues, develop practical solutions, lead cross-functional initiatives, and hold individuals accountable for measurable results. This person must be comfortable working directly with physicians, coding staff, billing and revenue cycle personnel, and executive leadership to translate findings into meaningful operational improvements. Core Responsibilities: 1. Coding Team Leadership and Performance Management • Lead and manage the day-to-day operations of the professional coding team, with direct responsibility for staff performance, productivity, accuracy, turnaround time, and quality., • Establish clear performance expectations, measurable departmental goals, and individual accountability standards., • Monitor coding production, work queues, backlogs, aging, quality metrics, and turnaround times; proactively address performance deficiencies., • Assign and balance workloads based on procedure complexity, coder experience, specialty expertise, and operational priorities., • Conduct regular team meetings, individual coaching sessions, performance reviews, and targeted training., • Identify skill gaps, develop improvement plans, and take appropriate corrective action when performance expectations are not met., • Develop standardized workflows, written procedures, escalation protocols, and cross-training plans to support consistent performance and business continuity., • Foster a culture of ownership, accountability, continuous improvement, and collaboration., • Ensure that the coding team operates efficiently and consistently meets established service-level expectations. 1. Technical Coding Oversight and Problem Resolution • Provide technical oversight of complex professional vascular surgery coding, including open and endovascular procedures, catheter-based interventions, imaging, hospital services, and evaluation and management (E&M) encounters., • Ensure appropriate CPT, HCPCS, ICD-10-CM, and modifier assignment in accordance with applicable AMA, CMS, NCCI, Medicare, and commercial payer requirements., • Serve as the escalation resource for complex coding cases, unusual operative reports, conflicting interpretations, and difficult coding scenarios., • Independently investigate coding discrepancies, identify root causes, and establish consistent, defensible resolutions., • Identify missed charges, undercoding, overcoding, incorrect modifier use, bundling errors, and documentation deficiencies., • Ensure appropriate application of vascular family and selective catheterization rules, global surgery requirements, and applicable bundling and reimbursement guidelines., • Develop standardized approaches to recurring coding questions and communicate decisions to the coding team., • Establish appropriate provider query processes when documentation is incomplete, ambiguous, or insufficient to support accurate coding., • Maintain current knowledge of coding changes, payer policies, regulatory requirements, and vascular surgery coding guidance. Technical oversight will encompass open vascular surgery, endovascular interventions, angiography and catheterization, thrombectomy and embolectomy, bypass procedures, dialysis access, atherectomy, stent placement, embolization, EVAR/TEVAR, carotid and peripheral interventions, hybrid procedures, and radiology supervision and interpretation. 1. Coding Audits, Quality Assurance, and Compliance • Develop and manage a structured coding audit program incorporating both prospective and retrospective reviews., • Establish risk-based audit priorities using procedure complexity, financial impact, historical error rates, payer requirements, provider documentation patterns, and denial trends., • Perform targeted audits to identify missed charges, coding inaccuracies, inconsistent practices, documentation gaps, and opportunities for improved reimbursement., • Track audit results by provider, coder, procedure category, error type, and financial impact., • Conduct root-cause analyses and implement corrective actions addressing the underlying causes of recurring errors., • Coordinate with providers to review audit findings, clarify documentation requirements, and implement corrective education., • Ensure audit findings translate into measurable changes in coding accuracy, documentation quality, and claim outcomes., • Maintain audit records, corrective action plans, education materials, and supporting documentation., • Escalate material compliance concerns to appropriate compliance and executive leadership., • Balance revenue optimization with coding integrity, medical necessity, and compliance requirements. 1. Revenue Optimization and Pre-Billing Claim Review • Establish proactive coding review processes to identify and correct coding and documentation issues before claims are released for billing., • Develop risk-based pre-billing review criteria for high-value procedures, complex operative reports, unusual coding combinations, and services with a history of missed charges or errors., • Review selected claims and encounters to identify opportunities for appropriate charge capture, complete coding, correct modifier assignment, and compliant reimbursement., • Work collaboratively with billing and revenue cycle leadership to identify and resolve coding-related claim issues before submission., • Analyze undercoding, missed charges, incomplete documentation, coding edits, and recurring billing corrections to identify systemic problems., • Develop processes to ensure all documented, billable services are captured appropriately without unbundling, unsupported coding, or other compliance violations., • Evaluate coding-related denials, underpayments, and reimbursement discrepancies to determine root causes and implement preventive measures., • Establish feedback loops between coding, billing, authorization, and clinical operations so that recurring issues are resolved at their source., • Measure the impact of coding improvement initiatives using appropriate indicators, including audit error rates, corrected claims, preventable denials, missed-charge findings, and net collectible revenue where measurable., • Recommend workflow changes that improve reimbursement accuracy and reduce rework, avoidable delays, and preventable revenue leakage. 1. Provider Education and Documentation Improvement • Develop and execute a structured provider education program based on audit findings, documentation deficiencies, coding trends, and revenue opportunities., • Establish regular provider feedback meetings to review coding and documentation patterns, explain deficiencies, and recommend practical improvements., • Present audit findings in a clear, objective, and actionable manner, using specific examples and appropriate coding guidance., • Develop provider-specific education plans where recurring documentation issues are identified., • Work directly with physicians and clinical leadership to improve operative reports, procedure notes, E&M documentation, and other records supporting professional claims., • Identify documentation improvements that support accurate reporting of the procedures performed and services provided., • Coordinate follow-up reviews to determine whether education has produced sustained improvement., • Maintain records of provider education, meetings, action items, and subsequent audit results., • Collaborate with clinical and administrative leadership to address documentation issues requiring broader workflow or practice-level changes. 1. Process Improvement and Project Execution • Identify operational problems, inefficient workflows, recurring errors, and opportunities to improve coding quality, staff productivity, documentation, and revenue performance., • Take ownership of assigned projects from problem identification through implementation, monitoring, and final evaluation., • Develop project plans that define the problem, root cause, proposed solution, responsible parties, implementation timeline, success measures, and expected results., • Lead initiatives such as provider education programs, coding audit projects, pre-billing claim review processes, workflow redesign, and corrective action plans., • Coordinate with physicians, billing, revenue cycle, authorization, clinical operations, compliance, and other stakeholders to implement changes., • Establish standardized workflows and controls to prevent recurring issues rather than relying on repeated manual correction., • Monitor implementation progress, identify obstacles, resolve issues, and hold responsible parties accountable for deliverables., • Evaluate project outcomes against established objectives and provide leadership with clear reporting on results., • Continuously assess existing processes for opportunities to improve efficiency, reduce rework, accelerate claim submission, and strengthen quality controls., • Demonstrate independent judgment and the ability to prioritize competing initiatives based on operational risk, financial impact, and organizational needs. 1. Analytics, Reporting, and Management Communication • Develop and maintain coding performance reports and dashboards that provide actionable insight into departmental operations., • Track key indicators, including:, • Coding productivity and accuracy., • Turnaround time, coding lag, and aged work queues., • Audit findings and error trends., • Provider-specific documentation deficiencies., • Pre-billing review findings and correction rates., • Missed-charge opportunities and coding-related revenue leakage., • Coding-related denials and claim corrections., • Staff performance, training needs, and improvement plans., • Project milestones and measured outcomes., • Use Microsoft Excel, EMR/PM reporting tools, and available analytics resources to investigate trends and identify root causes., • Distinguish isolated errors from systemic problems requiring workflow redesign, training, technology changes, or management intervention., • Present findings and recommendations clearly to revenue cycle and executive leadership., • Recommend corrective actions supported by data, financial impact, operational feasibility, and compliance considerations., • Follow up on implemented changes to confirm that improvements are sustained. 1. Technology, Automation, and Cross-Functional Collaboration • Evaluate opportunities to improve coding workflows through system enhancements, automation, reporting, and AI-assisted coding tools., • Participate in testing, implementation, and ongoing monitoring of coding technology., • Establish appropriate human review, quality assurance, and escalation procedures for automated coding outputs., • Work with billing and revenue cycle leadership to improve handoffs, reduce avoidable rework, and resolve coding-related claim issues., • Collaborate with authorization personnel to identify documentation or coding requirements that affect authorization and medical necessity processes., • Support the development of consistent policies and workflows across hospital, ASC, OBL, and office-based services., • Communicate operational risks, resource constraints, and improvement opportunities to leadership in a timely manner. Required Qualifications • At least 5–8 years of professional medical coding experience, including substantial hands-on vascular surgery coding experience., • Demonstrated experience managing, supervising, auditing, or leading a prof
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