Senior Manager Coding IP OP
POSITION SUMMARY:
Under the general supervision of the Clinical Documentation and Coding Integrity (CDCI) Director, the Senior Manager of Coding, IP/OP is responsible for guiding the inpatient (IP) and outpatient (OP) coding and reimbursement practices for BMC South and Brighton within established regulatory and organizational guidelines. This job provides direct oversight and supervision of coding staff and related workflows, develops and maintains coding guidelines for inpatient and outpatient services, responds to billing edits and related reports to ensure accurate Diagnosis-Related Group (DRG) and Ambulatory Patient Categories / Ambulatory Patient Groups (APC/APG) assignment, and enforces the appropriate application of Official Coding Rules and Regulations, including Coding Clinic guidance.
This job provides operational leadership and supervisory oversight of coding education and staff performance, conducts systematic data quality reviews, and supports documentation integrity to ensure compliance with federal, state, and institutional regulations. Additionally, it manages coding-related Recovery Audit Contractor (RAC) reviews, external coding audits, and coding-related denial responses to secure overall coding accuracy, compliance, and reimbursement integrity across the organization.
Position : Senior Manager Coding IP OP
Department : Clinical Documentation
Schedule : Full Time
ESSENTIAL RESPONSIBILITIES / DUTIES:
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Oversees daily inpatient (IP) and outpatient (OP) coding and reimbursement practices across BMC South and Brighton to ensure consistent application of regulatory and organizational coding standards, providing direction and oversight to coding staff as part of daily operational management.
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Develops, implements, and maintains standardized coding guidelines for inpatient and outpatient services, integrating updates from the Official Coding Guidelines and Coding Clinic.
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Reviews and analyzes complex billing edits, claim reports, and coding-related discrepancies daily to support accurate DRG and APC/APG assignments and execute corrections, including directing staff in the resolution of identified issues as needed.
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Enforces strict organizational compliance with applicable coding rules, official regulations, and internal policies by systematically monitoring coding practices and addressing deviations, including providing corrective guidance and performance feedback to coding staff when necessary.
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Conducts routine, structured data quality reviews of coded medical records to evaluate accuracy, consistency, and adherence to national documentation and coding requirements.
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Coordinates, designs, and delivers technical training and educational programs for coding staff regarding regulatory updates, advanced coding standards, and organizational policies, serving as a functional leader for coding staff development and competency building.
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Manages and coordinates institutional responses to external audits, including Recovery Audit Contractor (RAC) reviews and commercial payer audits, ensuring all documentation is submitted within required timelines, with oversight of staff participation and supporting work efforts as applicable.
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Resolves complex coding-related denial cases by reviewing determinations, validating historical coding accuracy, and preparing clinical appeals or supporting documentation, with responsibility for assigning and overseeing supporting work performed by coding staff as appropriate.
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Represents the Coding Department at interdisciplinary and clinical meetings to provide technical expertise on coding rules, documentation interpretation, and reimbursement implications, serving as a departmental lead and subject matter authority in coding operations.
(The above statements in this job description are intended to depict the general nature and level of work assigned to the employee(s) in this job. The above is not intended to represent an exhaustive list of accountable d