Manager, Professional Billing Coding Operations

🔥 0 minutes ago

🍂 Massachusetts – Remote

🍂 Massachusetts – Remote

💵 $78k - $113k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

⚙️ Operations

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Boston Medical Center (BMC)

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

Founded 1996

Boston Medical Center (BMC) is a 511-bed, equity-led academic medical center and a proud member of the Boston Medical Center Health System. BMC delivers a model of healthcare where innovative and equitable care empowers all patients to thrive. As a premier academic medical center in Boston, a national leader in clinical care, and the largest essential hospital in New England, BMC’s world-class clinicians provide comprehensive care in more than 70 specialties and subspecialties.

📋 Description

• Manage the day-to-day operations of the Professional Billing Coding Operations team • Supervise, develop, mentor, interview, orient, train, evaluate, hire, terminate, and discipline professional coding staff as necessary • Validate accurate CPT, HCPCS, ICD-10-CM, and diagnosis code assignment by coders, physicians, and non-physician practitioners • Review medical records, abstract diagnoses and procedures, sequence codes, and ensure accurate professional billing • Review coding denials, payer claim edits, RAC reviews, and other external coding reviews; identify root causes and trends • Conduct random chart audits and quality reviews to validate compliant code selection and documentation • Provide coding education, feedback, updates, and in-service training to coders, healthcare professionals, and Revenue Cycle staff • Partner with the Coding Education Team to design and implement coding, clinical documentation audit, and education programs • Establish staffing schedules, assign workloads and projects, and monitor productivity • Track overtime, absenteeism, hours worked, leave, and vacation/sick time; review and approve timesheets • Report on coding accuracy, abstracting, coding accountabilities, benchmarking profiles, and operational performance • Research coding issues, respond to coding questions, initiate documentation queries, and monitor responses • Ensure compliance with Official Coding Rules, Coding Clinic guidance, payer guidelines, CMS requirements, HIPAA, and hospital safety procedures

🎯 Requirements

• Bachelor’s degree or equivalent combination of formal education and experience • CPC – Certified Professional Coder certification required • At least five years of coding experience, including education, mentoring, and training • Minimum of five years of acute care hospital coding experience with ICD-10-CM and CPT-4 • Minimum of three years of management experience required; five years preferred • Prior experience working claim edits and denials • Excellent command of ICD-10-CM, CPT-4/HCPCS coding conventions, and E&M coding • Knowledge of human anatomy, physiology, and pathology • Skill in providing hands-on education based on audit findings and needs • Strong knowledge of health records, computerized billing and charging systems, Microsoft applications, data integrity, and processing techniques • Extensive knowledge of hospital inpatient and outpatient reimbursement methodologies • Extensive knowledge of payer claim edits and payer denials • In-depth knowledge of medical terminology, ICD-10-CM and CPT-4 coding conventions, CMS National Coverage Determinations, and applicable coding regulations and law • Excellent organizational, prioritization, multitasking, follow-through, problem-solving, accuracy, and attention-to-detail skills • Ability to collaborate with healthcare delivery teams, handle interruptions, adapt to workload and schedule changes, and respond to urgent requests • Ability to mentor, guide, and motivate direct reports • Must maintain strict confidentiality of personal and health-sensitive information and ensure HIPAA compliance • Must complete a background check before employment • Must be vaccinated against COVID-19 and flu and receive a COVID-19 booster dose

🏖️ Benefits

• Medical, dental, vision, and pharmacy benefits • Discretionary annual bonuses • Merit increases • Flexible Spending Accounts • 403(b) savings matches • Paid time off • Career advancement opportunities • Resources to support employee and family well-being • Employee vaccination requirement coverage/context: COVID-19 and flu vaccination and COVID-19 booster • Accommodation support during the application process