Job Overview:

We are seeking a highly skilled and dynamic Medical Coding Manager with expertise in pediatric practice management to lead our coding operations. This individual will be responsible for ensuring accurate coding practices company-wide, evaluating appropriateness of CPT and ICD10 codes assigned to each patient prior to claim submission. The Medical Coding Manager will be responsible for determining diagnosis hierarchy and CPT to ICD10 pointing, providing input on coding workflows, and working cohesively with clinical providers to educate them on coding optimization. The Medical Coding Manager must possess the ability to understand complex documentation relative to Value Based Care.

Key Responsibilities:

• Oversee and manage coding operations specific to pediatric healthcare services, ensuring compliance with all regulatory guidelines (e.g., ICD-10, CPT, CMS).
• Serve as the subject matter expert in pediatric coding, providing guidance to coding teams, clinicians, and administrative staff.
• Ensure accurate and timely coding per patient visit before claim submission, focusing on reducing denials and optimizing reimbursement processes for pediatric services.

Provider Training & Education:

• Works with the clinical documentation specialist to offer advice regarding coding protocols relative to claim guidance and regulations. Educates clinical staff on coding relative to claim errors and rules.
• Conduct “chart to bill” audits to ensure proper codes are utilized for patient specific visits
• Act as a liaison between clinical and RCM teams to address concerns and educate each team as necessary.

AI Integration and Process Optimization:

• Stay up to date on advancements in AI technologies related to coding and healthcare billing.
• Colaborates with clinical documentation specialist and RCM leadership to integrate AI-driven coding solutions to enhance productivity, accuracy, and efficiency.
• Collaborate with IT and data science teams to implement AI tools and assess their impact on coding performance and revenue cycle management.

Leadership & Team Management:

• Lead, mentor, and develop a team of coding professionals to ensure consistent quality in coding practices.
• Provide strategic oversight and direction for coding activities, ensuring alignment with the organization’s goals and regulatory requirements.
• Partners with RCM leadership to optimize the revenue cycle and support the organization’s financial health.

Compliance & Regulatory Monitoring:

• Ensure adherence to all federal, state, and local regulations, including HIPAA, CMS, and payer-specific requirements.
• Review and update coding policies and procedures regularly to reflect changes in coding standards, regulatory guidelines, and payer requirements.

Qualifications:

Education:

• Bachelor’s degree in Health Information Management preferred.
• Certification in coding (AAPC or AHIMA (COC, CPC, CPEDC) required, but pediatric certified (CPEDC) preferred.

Experience:

• Minimum of 5 years of experience in healthcare coding, with a significant focus on pediatric services preferred.
• Proven experience in claim requirements for coding.

Skills:

• Strong knowledge of ICD-10-CM, CPT, and HCPCS coding standards, with a focus on pediatric codes.
• Excellent training, presentation, and communication skills, with the ability to translate claim requirements relative to coding to clinical and RCM staff.
• Experience in managing coding teams and cross-departmental collaborations.
• Strong communications skills with providers.

Key Competencies:

• Strong analytical and problem-solving skills.
• Ability to adapt to new technologies and lead organizational change.
• Detail-oriented with the ability to manage multiple priorities.
• Strong interpersonal and communication skills with the ability to build relationships across various departments.

Why Join Us?

As a Coding Manager, you’ll play a pivotal role in shaping the future of pediatric healthcare RCM operations within our organization. Your expertise in pediatric coding, ability to train staff, and forward thinking relative to AI applications will contribute to improving healthcare outcomes and operational efficiency.

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Location:

• Florida (Required)

Work Location: Remote