HIM Coding Manager Auditing and Education - HIM Financial - Full Time 8 Hour Days (Exempt) (Non-Union)

About this role

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. The Manager supervises coding auditors, educators, denials management specialists, and Coder Editor Team, and is responsible for planning, organizing, and directing coding audit activities, coding education initiatives, and pre-bill coding-related-edits from billing systems. This role collaborates closely with Coding Operations, Clinical Documentation Integrity (CDI), Compliance, Revenue Integrity, Patient Financial Services, physician-providers, and non-physician providers to support revenue cycle performance and regulatory compliance. The Manager serves as a subject matter expert in coding regulations and provides leadership in the development and implementation of coding education, audit programs, facilitating educational webinars and seminars, planning and delivering effective presentations, and process improvement initiatives.

Essential Duties: • Manage IP & OP Coding Audit Programs & Team • Provide leadership and oversight of inpatient and outpatient coding audit programs and staff, ensuring timely completion of audits and adherence to established quality standards and performance benchmarks. • Direct the review and analysis of internal and external audit findings; identify coding trends and risk areas; and implement corrective action plans to improve coding accuracy and reduce compliance risk. • Develop, implement, and maintain coding audit strategies aligned with CMS, OIG, and internal compliance standards. • 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 to address coding and documentation issues. • Participate in recruitment, hiring, onboarding, and training of coding auditors. • Oversee preparation of executive-level audit reports and present findings and recommendations to KMoUSC Compliance Dept., HIM and Revenue Cycle leadership. • Coordinate with Compliance leadership to review and respond to internal and external audit results. • Coding Education Program Leadership • Provide strategic oversight of inpatient and outpatient coding education programs. • Direct the development and maintenance of coding orientation and training programs for coding staff. • 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 and ensure timely education of affected staff. • Oversee analysis of coding and clinical documentation impacts on reimbursement and identify improvement opportunities. • Manage OP Coding Editor Program, Functions, & Team • Provide leadership and oversight of the Coding Editor program and staff responsible for resolution of post-coding pre-bill edits. • 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, including OCE/NCCI edits, CMS and MAC guidance, and payer policies. • Oversee resolution of complex coding-related edits and denial prevention activities. • Direct coding-related denial prevention and reimbursement recovery efforts in collaboration with Revenue Cycle leadership. • Collaborate with Patient Financial Services (PFS), HIM Coding Support, and CDI leadership to resolve medical necessity provider documentation issues. • Denials Management • Denials Triage & Resolution: Review and triage PFS-related, coding-related, and clinical-related denials and DRG downgrades. • Denials Danagement: Manage and resolve coding-related inpatient and outpatient claim denials, rejections, and DRG downgrades. • Appeals Management: Prepare, develop comprehensive rebuttal letters and appeal packages, submit, and track first- and second-level coding-related appeals to Medicare, Medi-Cal, MACs, RACs, QIOs, and commercial payers. • Regulatory, Coding & Clinical Research Oversight • Maintain advanced knowledge of legal, regulatory, and policy requirements related to coding and documentation. • Direct regulatory and coding research activities using authoritative resources including IPPS/OPPS Federal Register publications, NCDs, LCDs, NCCI edits, Official Coding Guidelines, Coding Clinic, and CPT Assistant. • 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. • Root Cause Analysis & Process Improvement • 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. • Reporting & Performance Monitoring • 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 r

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