MedConverge - Manager - Medical Coding - US Healthcare RCM

Position Summary:

We are seeking a highly skilled, experienced, and results-driven Manager of Medical Coding to lead and inspire our medical coding team. This pivotal role requires a comprehensive understanding of medical coding principles, U.S. healthcare regulations, and end-to-end RCM workflows. The successful candidate will have a proven track record of driving coding accuracy, efficiency, and compliance, ultimately contributing to optimised revenue capture. This position requires a minimum of 10 years of progressive experience in medical coding, including substantial leadership and supervisory responsibilities.

Key Responsibilities:

- Conduct regular performance evaluations, provide constructive feedback, and identify professional development and training opportunities for team members.

- Oversee daily coding operations, ensuring efficient workflow, equitable workload distribution, and adherence to productivity and quality targets.

- Participate actively in the recruitment, interviewing, and onboarding of new coding professionals.

- Ensure the highest level of accuracy, completeness, and compliance for all medical coding (CPT, HCPCS, ICD-10-CM, modifiers) across diverse specialities and healthcare settings (e.g., professional, facility, inpatient, outpatient).

- Maintain expert-level knowledge of all federal and state coding guidelines, payer policies, and regulatory updates (e.g., CMS, AMA, OIG, HIPAA) and proactively ensure team compliance.

- Design and implement robust coding audit programs, providing targeted education and corrective action plans based on audit findings to uphold stringent quality standards.

- Develop and monitor coding quality control processes to minimise claim denials, rejections and optimise reimbursement.

- Collaborate cross-functionally with other RCM departments (e.g., billing, accounts receivable, denials management, credentialing) to identify, analyse, and resolve coding-related denial trends and root causes.

- Proactively identify and implement process improvements within the coding function to enhance overall RCM efficiency, accelerate cash flow, and improve financial performance.

- Analyse complex coding data and trends to provide actionable insights and recommendations to senior management.

- Drive initiatives to reduce coding-related claim rejections and accelerate the revenue cycle.

- Develop, deliver, and manage comprehensive training programs for new and existing coders on coding guidelines, software updates, payer-specific requirements, and compliance protocols.

- Provide ongoing education, support, and resource guidance to the coding team to ensure continuous learning and adaptation to evolving industry changes.

- Serve as the primary subject matter expert for complex coding inquiries, providing authoritative guidance to internal stakeholders and external clients as needed.

- Leverage and optimise various coding software, Electronic Health Record (EHR) systems, and RCM platforms to streamline coding processes.

- Generate, interpret, and present detailed coding performance reports, including productivity, accuracy, and denial rates, to senior management with strategic recommendations.

- Contribute to the evaluation, selection, and implementation of new coding technologies or tools to enhance departmental capabilities.

Qualifications:

- Minimum of 10 years of progressive experience in medical coding within the US healthcare RCM environment, with at least 5 years in a dedicated leadership, supervisory, or management role.

- Current, active certification(s) from a recognised organisation are required (e.g., CPC, CCS, CIC).

- Exceptional, in-depth knowledge of CPT, HCPCS, ICD-10-CM coding systems, medical terminology, human anatomy, and physiology.

- Comprehensive understanding of US healthcare regulations, compliance requirements (e.g., HIPAA), and commercial/government payer guidelines.

- Extensive experience across various medical specialties and coding types (e.g., Evaluation & Management (E/M), surgical, radiology, pathology, inpatient, outpatient hospital, professional fee).

- Superior analytical, critical thinking, and problem-solving skills with the ability to identify trends, troubleshoot complex issues, and implement effective, sustainable solutions.

- Outstanding written and verbal communication, interpersonal, and presentation skills, with the ability to articulate complex coding concepts clearly and concisely.

- High proficiency in Microsoft Office Suite (Excel for data analysis, Word, PowerPoint) and experience with various RCM/EHR systems and coding software.

- Demonstrated ability to effectively manage, motivate, and develop a team in a fast-paced, high-volume, and deadline-driven environment.

- A bachelor's degree in Health Information Management, Healthcare Administration, Business, or a related field is strongly preferred. Commensurate experience may be considered in place of a degree.