Under the direction of the Revenue Cycle Director, the Revenue Integrity Coding Manager oversees coding operations within the revenue cycle, ensuring compliance with regulatory requirements and coding accuracy. This role manages pre-accounts receivable (pre-AR) processes, coordinates coding activities, and educates physicians on proper coding practices, while also overseeing billing processes related to coding and contributing to the development of new service lines or clinical programs at Central Health. The Manager is responsible for daily departmental operations, including staffing, work assignment distribution, and adherence to revenue integrity guidelines. They ensure timely and accurate charge capture activities and develop policies and procedures to support accurate reimbursement while maintaining patient and physician satisfaction. Additional
responsibilities include disseminating current coding and charge capture guidelines, providing updates to the Epic system, and analyzing reimbursement trends to optimize revenue across all departments. The Manager also leads training initiatives for clinical providers and revenue cycle staff to ensure compliance with regulations and proper coding practices. Furthermore, this role involves tracking, managing, and implementing strategies to maintain compliance and enhance efficiency across the revenue cycle.

Essential Functions:

• 1. Revenue Integrity Oversight - Monitor and audit revenue cycle processes to identify and prevent revenue leakage. Ensure accurate charge capture, coding, and billing practices across clinical departments. Collaborate with clinical and administrative teams to streamline workflows for revenue optimization.
• 2. Compliance Management - Ensure compliance with federal, state, and payer-specific billing regulations. Stay updated on changes in coding guidelines (e.g., ICD-10, CPT, HCPCS) and reimbursement policies. Develop and enforce policies and procedures to maintain adherence to regulatory requirements.
• 3. Data Analysis and Reporting - Analyze revenue trends and financial data to identify discrepancies or improvement opportunities. Prepare regular reports on revenue performance, charge capture metrics, and reimbursement outcomes. Investigate and resolve discrepancies between expected and actual reimbursement.
• 4. Training and Education - Provide ongoing education and training to physicians, coders, and revenue cycle staff on documentation, coding, and compliance requirements. Communicate updates on coding regulations, payer policies, and revenue cycle best practices.
• 5. Collaboration and Communication - Act as a liaison between clinical departments, finance, and revenue cycle teams to address revenue integrity issues. Work with IT teams to ensure billing systems and electronic health records (e.g., Epic) are configured correctly for charge capture and coding.
• 6. Policy Development - Develop, implement, and maintain policies and procedures to support accurate charge capture and billing. Establish best practices for the integration of new clinical services or programs into the revenue cycle.
• 7. Leadership and Team Management - Lead and manage teams responsible for charge capture, coding, or revenue cycle audits. Oversee staffing, work assignments, and team performance to ensure efficient operations.
• 8. Pre-AR and Denials Management - Oversee pre-accounts receivable (pre-AR) processes, ensuring accurate documentation and coding prior to claim submission.
  Identify root causes of denials and implement corrective actions to minimize future occurrences.
• 9. Strategic Initiatives -  Support the development and implementation of new service lines or clinical programs to ensure financial feasibility and compliance. Participate in revenue cycle improvement initiatives and long-term strategic planning.
• 10. Patient and Provider Satisfaction -  Address concerns related to billing accuracy and coding issues to maintain satisfaction among patients and physicians. Act as a resource for resolving complex billing or coding inquiries. 

Knowledge, Skills and Abilities:

• Revenue Cycle Management Knowledge: Comprehensive understanding of the end-to-end revenue cycle, including charge capture, coding, billing, and reimbursement.
• Regulatory Compliance Expertise: Deep knowledge of healthcare regulations, including
• Medicare/Medicaid policies, HIPAA, and payer-specific billing requirements.
• Coding Proficiency: Expertise in ICD-10, CPT, HCPCS, and other coding systems, including the ability to ensure accuracy and adherence to guidelines.
• Analytical and Problem-Solving Skills: Strong ability to analyze revenue trends, identify discrepancies, and implement actionable solutions.
• Leadership and Team Management: Proven skills in managing teams, assigning work, and fostering collaboration to meet organizational goals.
• Communication and Education Skills: Ability to effectively train and educate providers, staff, and leadership on coding practices and regulatory updates.
• Technical Proficiency: Experience with healthcare IT systems, such as Epic, and other revenue cycle and reporting tools.
• Policy Development Skills: Capability to create, implement, and enforce policies and procedures for revenue integrity and compliance.
• Attention to Detail: Precision in ensuring coding accuracy, proper charge capture, and audit  readiness.
• Adaptability and Strategic Thinking: Flexibility to navigate changes in regulations or payer requirements while aligning initiatives with organizational goals.

Minimum Education: Bachelor’s degree in business related field or 10 years equivalent experience.

Minimum Experience: 

• 5 years of relevant healthcare revenue or medical billing cycle experience, which includes coding Required
• 4 years Minimum of 4 years of experience in a leadership role Required 

Licenses/Certifications:

• Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) Upon Hire Required