Description:

Role Overview:

The Coding Operations Manager is responsible for end-to-end oversight of coding quality, accuracy, and productivity across multiple functional teams.

This leader manages coding integrity, prebill validation processes, reconciliation workflows, and staff performance, ensuring adherence to regulatory guidelines and organizational standards.

The role requires deep technical coding expertise, strong leadership skills, and the ability to drive continuous quality improvement in a fast-paced environment.

Key Responsibilities:

Leadership & Team Management:

- Provide direct managerial oversight to Coding Integrity Specialists (CIS I, II, III), CARS (IIII), Coding Leads, CDI Liaisons, and Coding Mentors.

- Supervise all work processes including quality reviews, education activities, reconciliation, and coding validation workflows.

- Coach, mentor, and develop team members; address performance issues, disciplinary actions, and resolve dysfunctional behaviors within the team.

- Select, train, evaluate, and provide leadership to staff ensuring high performance and adherence to coding standards.

Coding Quality, Accuracy & Compliance:

- Ensure complete, accurate, timely, and compliant coding following ICD-10-CM, ICD-10-PCS, CPT/HCPCS, MS-DRGs, APR DRGs, and organizational policies.

- Oversee ongoing coding quality improvement initiatives using trend analysis, audit findings, and feedback loops.

- Partner with Coding Mentors and Quality teams to deliver education sessions, coding refreshers, and quality improvement plans.

CPART & Coding Validation Management:

- Manage the Coding Prebill Account Review Tool (CPART) to ensure accurate DRG/code validation prior to billing.

- Monitor coding validation workflows, reconcile discrepancies, and ensure GL compliance and audit readiness.

Operational Excellence & Productivity Management:

- Proactively manage productivity, TAT (turnaround time), quality metrics, workflow processes, staffing schedules, and performance benchmarks.

- Identify operational bottlenecks and implement process improvements for efficiency and scalability.

- Maintain communication across teams regarding workflow changes, forecasting, and project updates.

Data Analysis & Performance Reporting:

- Review coding and clinical documentation improvement (CDI) reconciliation reports, highlight improvement opportunities, and track outcomes.

- Analyze Case Mix Index (CMI) trends to identify root causes affecting coding quality or reimbursement.

- Provide periodic reports to leadership with insights, risks, and action plans.

Collaboration & Stakeholder Management:

- Develop and maintain strong working relationships with key internal stakeholders to ensure effective communication and resolution of operational issues.

- Collaborate with CDI, Revenue Integrity, Operations, and other teams to drive coding compliance and accuracy.

- Support problem-solving, conflict resolution, and cross-functional project coordination.

Scheduling & Resource Planning:

- Ensure staff schedules meet SLA requirements and support business continuity.

- Monitor workload distribution, ensure equitable resource allocation, and plan ahead for peak volumes.

Required Skills & Qualifications:

- Extensive knowledge of ICD-10-CM, ICD-10-PCS, CPT/HCPCS, MS-DRGs, APR DRGs, coding compliance, and reimbursement methodologies.

- Strong analytical skills especially in Case Mix Index (CMI) evaluation and trend analysis.

- Proven leadership experience managing large HIM/coding teams.

- Excellent critical thinking, decision-making, and problem-solving abilities.

- Strong interpersonal and communication skills for building and maintaining strategic relationships.

- Ability to manage multiple priorities in a fast-paced, deadline-driven environment.

Preferred Qualifications:

- RHIA, RHIT, CCS, CPC, or related coding credentials strongly preferred.

- Experience in hospital/acute care coding environment