Manager, Professional Billing Coding Operations

🔥 12 hours ago

🇺🇸 United States – 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 • Validate accurate CPT, HCPCS, and diagnosis code assignment • Review medical records and abstract diagnoses and procedures using ICD-10-CM and CPT-4/HCPCS • Sequence diagnoses, procedures, and complications according to coding and regulatory guidelines • Review and resolve coding questions, edits, denials, and accountabilities • Conduct random chart audits and quality reviews • Analyze benchmarking profiles and report coding accuracy and abstracting results • Provide coding updates, research coding issues, and clarify documentation with medical staff • Manage, develop, mentor, interview, orient, train, evaluate, hire, terminate, and discipline coding staff as needed • Establish staffing schedules and assign workloads and projects • Provide coding and documentation training to healthcare professionals, coders, and Revenue Cycle staff • Develop strategies to improve coding efficiency and team productivity • Track overtime, absenteeism, hours, leave, and vacation/sick time; review and approve timesheets • Participate in coding and reimbursement meetings • Support RAC and other external coding reviews and payer reviews • Follow hospital infection control and safety procedures

🎯 Requirements

• Bachelor’s degree or equivalent combination of formal education and experience • CPC – Certified Professional Coder • At least five years of coding experience, including education, mentoring, and training • Minimum of five years acute care hospital coding experience with ICD-10-CM and CPT-4; academic medical setting or trauma center preferred • Minimum of three years management experience required; five years preferred • Prior experience working claim edits and denials • Excellent command of ICD-10-CM and CPT4/HCPCS coding conventions, including E&M coding • Knowledge of human anatomy, physiology, and pathology • Skill in providing hands-on education to PB Coding Operations staff • Strong knowledge of health records, computerized billing and charging systems, Microsoft applications, data integrity, and processing techniques • Knowledge of hospital inpatient and outpatient reimbursement methodologies • 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 • Ability to maintain HIPAA confidentiality and compliance • Excellent organizational, problem-solving, multitasking, prioritization, and follow-through skills • Ability to mentor, guide, and motivate direct reports • Ability to work cooperatively with healthcare delivery teams, handle interruptions, adapt to workload and schedule changes, and respond to urgent requests

🏖️ 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