Coding Manager

Primary Purpose of the Position:

The Revenue Cycle Coding Manager provides strategic and operational leadership for professional coding and charge capture. The Manager is accountable for coding quality, productivity, inventory, compliance remediation, workforce planning, vendor performance, physician and division engagement, and coding-related revenue integrity. The position establishes clear standards, analyzes trends, and develops corrective action plans to support accurate, timely, and compliant claim submission.

Essential Duties of the Position May Include the Following:

• Leads day-to-day and long-range coding operations, including staffing, workload allocation, coverage planning, production priorities, and escalation management.
• Owns the coding operating model and clearly defines responsibilities among the Coding Manager, Coding Supervisor, internal coders, and external coding vendors.
• Establishes, monitors, and reports key performance indicators for coding inventory, coding lag, productivity, quality, rework, denials, charge capture, and vendor performance.
• Analyzes weekly and monthly trends, identifies root causes, and develops documented action plans with owners, milestones, and follow-up monitoring.
• Monitors and oversees all coding worklists and intake channels, including SharePoint, ECC, Athena, surgical schedules, urgent requests, and unlisted or ad hoc code holds. Escalates risks to the Revenue Cycle Sr. Manager and Director that may delay claim submission or cash flow.
• Determines staffing requirements and makes recommendations regarding recruitment, scheduling, cross-training, overtime, and vendor support based on volume, specialty complexity, quality, and turnaround expectations.
• Selects and evaluates coding staff, completes performance reviews, addresses performance concerns, and ensures timely coaching and corrective action in partnership with Human Resources and department leadership.
• Provides oversight of the Coding Supervisor, including expectations for daily production management, staff training, quality reviews, timekeeping, and operational reporting.
• Oversees coding vendor relationships, including work allocation, service levels, turnaround times, quality requirements, issue resolution, and validation of vendor-reported performance and invoices.
• Partners with Compliance to maintain a risk-based coding audit program, review internal and external audit findings, develop corrective action plans, and verify that remediation and education are completed and sustained.
• Ensures coding corrections are supported, approved, documented, and communicated through established workflows; maintains appropriate audit trails and segregation of duties.
• Partners with physicians, surgeons, division leadership, and clinical management to improve documentation, coding accuracy, charge capture, and timely resolution of coding questions.
• Develops targeted physician, division, coder, and vendor education based on audit findings, denial trends, payer requirements, new services, and recurring documentation deficiencies.
• Oversees coding-related denial and underpayment analysis, including modifier, bundling, medical necessity, provider enrollment, CCS/Medi-Cal, and documentation trends; coordinates resolution with Billing, Collections, Compliance, and division leadership.
• Oversees governance for new procedures, new CPT/HCPCS codes, unlisted services, fee schedule requests, and charge description changes, including approval routing, pricing support, implementation, testing, and turnaround standards.
• Maintains current coding content in electronic charge capture tools, fee schedules, work queues, and reference materials; coordinates system updates and validates that changes are implemented accurately.
• Ensures current knowledge and operational application of CPT, HCPCS, ICD-10-CM, modifiers, CMS NCCI and MUE edits, payer policies, Medi-Cal, CCS, and other applicable requirements.
• Maintains department policies, procedures, desk-level workflows, training materials, business continuity plans, and records needed to support consistent operations and audit readiness.
• Leads regular team meetings and creates a psychologically safe forum for operational concerns, workflow improvements, and escalation of compliance risks.
• Performs operational analyses and special projects assigned by Revenue Cycle leadership.

Required Knowledge and Experience:

• Active CPC through AAPC or CCS through AHIMA required. Specialty coding credentials are desirable.
• Minimum five years of progressive professional coding or revenue cycle experience, including demonstrated leadership responsibility; pediatric, surgical, and multi-specialty experience strongly preferred.
• Demonstrated knowledge of professional fee coding, charge capture, claims editing, denials, reimbursement, and payer requirements.
• Advanced knowledge of medical terminology, anatomy and physiology, CPT, HCPCS, ICD-10-CM, modifiers, CMS NCCI edits, and MUEs.
• Working knowledge of Medi-Cal, CCS, Medicare, managed care, capitation, and commercial payer requirements relevant to a pediatric multi-specialty medical group.
• Ability to interpret remittance advice, explanation of benefits, payer policies, audit results, and contract or fee schedule provisions relevant to coding and reimbursement.
• Experience managing coding inventory, productivity, quality, audit remediation, and vendor performance using reliable data and documented controls.
• Bachelor’s degree from an accredited college or university preferred.

Leadership and Technical Skills:

• Ability to communicate effectively with coders, vendors, physicians, clinical leaders, Compliance, Finance, and Revenue Cycle stakeholders.
• Ability to translate trends and risks into clear decisions, corrective actions, and executive-level reporting.
• Advanced proficiency with spreadsheets, reporting tools, word processing, collaboration platforms, and coding or practice management systems; Athena experience is preferred.
• Ability to handle multiple tasks. 
• Ability to meet deadlines and to follow assignments through to completion.
• Ability to organize and manage time effectively.
• Ability to manage confidential information in accordance with HIPAA, privacy, security, and organizational requirements.
• Effective leadership skills with a team-oriented approach