Job Summary
We are seeking an experienced Coding Quality Manager to lead our Coding Quality and Audit team. This role is responsible for overseeing coding quality assurance programs, managing coding audits, and delivering education to coding professionals and providers to ensure compliance with CMS regulations, official coding guidelines, and industry standards.
The ideal candidate has extensive experience in Orthopedic Surgery and/or Evaluation & Management (E/M) coding audits, strong leadership skills, and a deep understanding of ICD-10-CM, CPT, HCPCS, and physician coding compliance.
Key Responsibilities
- Lead and manage the Coding Audit and Education team, providing coaching, guidance, and performance oversight.
- Develop, implement, and maintain coding quality assurance and audit programs.
- Conduct coding audits to ensure compliance with CMS regulations, coding guidelines, and organizational policies.
- Identify coding trends, compliance risks, and opportunities for process improvement.
- Develop and deliver coding education and training sessions for providers, coders, and revenue cycle teams.
- Provide coding guidance and serve as a subject matter expert on physician documentation and coding compliance.
- Review and respond to external payer, compliance, and regulatory audits.
- Monitor coding quality metrics and prepare reports for leadership.
- Ensure the team remains current on ICD-10-CM, CPT, HCPCS, CMS regulations, and annual coding updates.
- Collaborate with cross-functional teams to resolve coding and documentation inquiries.
- Drive continuous quality improvement initiatives to enhance coding accuracy and compliance.
Qualifications
- Minimum 4 years of coding audit experience in Orthopedic Surgery and/or Evaluation & Management (E/M) coding. Experience in other surgical specialties will also be considered.
- Minimum 2 years of supervisory or people management experience leading coding teams.
- Active coding certification from AAPC:
- CPC
- CPMA
- COSC
- CEMC
- AHIMA certifications (CCS-P or CCS) are also considered with relevant physician coding audit experience.
- Associate's or Bachelor's degree in Health Information Management, Health Services Administration, or a related field is preferred.
- Intermediate to advanced proficiency in Microsoft Excel and Microsoft Office applications.
- Must successfully pass a coding assessment.
Preferred Skills
- Strong knowledge of:
- ICD-10-CM
- CPT
- HCPCS
- CMS regulations
- Official Coding Guidelines
- NCCI edits
- Knowledge of disease processes, medical terminology, anatomy, physiology, and pharmacology.
- Excellent analytical and auditing skills with exceptional attention to detail.
- Strong communication, presentation, and coaching abilities.
- Proven ability to mentor and develop coding professionals.
- Ability to work independently in a fast-paced virtual environment while managing multiple priorities.
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