Manager, Coding Education & Performance

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Position Summary:

RESPONSIBILITIES & DUTIES

• Design and deliver ongoing education programs for providers related to CPT ICD-10 HCPCS modifiers and E/M coding
• Conduct Pro Fee and Outpatient Coding audits of provider documentation and coding practices for accuracy completeness and compliance with payer and regulatory guidelines.
• Independently conduct reviews/audits on the adequacy of medical record documentation to support the codes selected by clinicians coders and coding vendors in accordance with professional standards organizational policies and procedures laws and regulations.
• Pursues education and training opportunities to assure compliance with current laws rules and regulations by participating in professional education activities and obtaining and maintaining relevant certifications.
• Analyze audit trends to identify training opportunities common errors and documentation gaps.
• Maintain up-to-date knowledge of CMS Medicaid commercial payer and industry standards for professional billing and coding.
• Participate in policy development coding updates and interdepartmental collaboration on coding compliance and billing initiatives.
• Escalate potential compliance risks or systemic issues to Revenue Cycle or Compliance leadership as needed.
• Sequences diagnoses procedures and complications by following ICD-10-CM Medicare Medicaid and other fiscal intermediary guidelines.
• Support implementation of coding changes related to payer policy or regulatory updates.
• Participate in professional development and maintain active coding certification(s).
• Lead or assist with quality assurance reviews across multiple specialties.

EDUCATION:

• Preferred: Bachelors degree in Health Information Management Health Administration or a related field
• Familiarity with Massachusetts payer guidelines Medicare Medicaid regulations and clinical documentation improvement

Certifications:

• Required: Certified Professional Coder (CPC) and/or Certified Risk Adjustment Coder (CRC)
• Preferred: Additional auditing or documentation certifications (e.g. CPMA CCS)

EXPERIENCE:

• 10 years of experience in professional and outpatient coding provider education or risk adjustment auditing
• Experience delivering coding education and conducting audits across multiple specialties
• Extensive knowledge of cpt revenue codes ICD-10-CM coding and HCC/risk adjustment methodologies
• Experience with Medicare Advantage risk models and patient documentation integrity
• Knowledge of healthcare administrative processes such as reimbursement policies and procedures payer contracting operations and billing regulations
• Strong management and staff development skills
• Proven analytics and performance improvement
• Knowledge of health care industry trends
• Extensive knowledge of Federal and State insurance programs (MassHealth)
• Independently interpret and analyze medical record documentation to ensure accurate coding assignment for Medical Decision Making (MDM) versus Time-based CPT selection including the appropriate use of modifiers and diagnosis documentation. Provide structured feedback to providers coding staff and vendor partners to support continuous quality improvement and adherence to coding regulations. Collaborate with IT and the Informatics team to identify EPIC workflow or system improvements that enhance coding accuracy documentation compliance and revenue integrity outcomes. Actively contribute to education and process development efforts that strengthen provider understanding and compliance with professional coding standards and payer requirements.
• Experience interacting with physicians and clinical support regarding coding guidelines (written and verbal)
• Extensive knowledge of Revenue codes CPT and ICD-10 coding across multiple medical specialties
• Ability to lead supervise and train staff
• EPIC experience preferred

PAY RANGE:

Starts at $99226 up to $153800 annually based on experience

EEO & Accommodation Statement:

NeighborHealth is an equal employment/affirmativeaction employer. We ensure equal employment opportunities for all without regard to race color religion sex national origin age disability veteran status sexual orientation gender identity and/or expression or any other non-job-related characteristic. If you need accommodation for any part of the application process because of a medical condition or disability please send an e-mail toor call to let us know the nature of your request

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NeighborHealth participates in the Electronic Employment Verification Program E-Verify. As an E-Verify employer all prospective employees must complete a background check before beginning employment.