"Manager Coding Compliance (Hybrid) - Emergency Medicine"

Position Summary

Provides operational and managerial leadership for coding compliance and charge capture activities supporting hospital-based and professional services. This position handles the day-to-day operations of charge capture activities, assuring regulatory compliance while maximizing appropriate revenue. Reporting within the revenue cycle/compliance structure, this role partners directly with faculty, coders and operational leaders, conducts audits and education, and serves as a liaison to institutional compliance functions. The role exercises independent judgment within established policies and contributes to departmental performance, risk mitigation, and revenue integrity.

Job Description

Primary Duties & Responsibilities:

Charge Capture & Coding Operations:

• Partners with Coding and Billing staff to ensure hospital-based services are captured timely, accurately, and compliantly to maximize appropriate revenue.
• Works directly with external coding vendors to ensure adherence to federal, state, payer, and organizational coding and billing compliance requirements.
• Serves as the primary compliance liaison with the coding vendor, overseeing audit findings, corrective actions, and ongoing compliance monitoring.
• Collaborates with the coding vendor to identify, address, and prevent compliance risks related to coding accuracy and regulatory standards.

Coding Compliance & Auditing:

• Performs compliance duties including medical record reviews, physician audits, and OPBC audits.
• Ensures OPBC and departmental compliance guidelines are consistently applied to billed services.
• Analyzes audit findings and charges capture trends; develops and implements corrective actions within the department’s authority.

Faculty & Provider Engagement:

• Directly interacts with clinical providers regarding coding, charge capture, compliance, and billing issues.
• Develops educational materials and conduct regular meetings with clinical providers to improve coding accuracy and documentation quality.
• Serves as a subject matter expert for complex coding and compliance questions within assigned scope.

Education & Staff Development:

• Ensures staff attendance at required training and in-services.
• Provides targeted education to coding staff and providers based on audit results, regulatory updates, and performance trends.
• Coaches staff on best practices and adherence to policies.

Policy, Regulation & Process Management:

• Communicates billing policies and procedures to staff to promote efficient, compliant workflows.
• Maintains current knowledge of Medicare, Medicaid, HMO, PPO, and other payer requirements affecting operations.
• Recommends process improvements and participate in system or workflow enhancements.

Leadership, Collaboration & Reporting:

• Serves as compliance liaison to the WU Office of Physician Billing Compliance.
• Collaborates with Revenue Cycle, Billing, Compliance, Clinical Operations, and IT to resolve issues and improve outcomes.
• Prepares routine operational and compliance reports for departmental leadership.
• Exercises independent judgment within established policies and procedures.
• Accountable for operational outcomes (timeliness, accuracy, compliance) within assigned services.
• Influences clinical providers and cross-functional partners

Third-Party Vendor Oversight & Partnership:

• Serves as the primary operational liaison for the department’s third-party coding vendor as it relates to auditing, departmental workflows, compliance standards, and provider education.
• Reviews vendor work output, identifies trends or issues, and collaborates with vendor to implement corrective actions and process improvements.
• Coordinates vendor-supported audits, education, or supplemental coding services as needed to support departmental operations.
• Escalates performance, compliance, or operational concerns through appropriate leadership and governance channels.
• Partners with internal stakeholders to ensure vendor activities remain compliant with institutional policies and OPBC requirements.

Working Conditions:

Job Location/Working Conditions: Normal office environment.

Physical Effort: Typically sitting at a desk or a table.

Equipment: Office equipment.

The above statements are intended to describe the general nature and level of work performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all job duties performed by the personnel so classified. Management reserves the right to revise or amend duties at any time.

Required Qualifications

Education: Bachelor’s degree or combination of education and/or experience may substitute for minimum education.

Certifications/Professional Licenses: No specific certification/professional license is required for this position.

Work Experience: Supervisory (5 Years)

Preferred Qualifications

Certifications/Professional Licenses: Certified Coding Specialist (CCS) - American Health Information Management Association (AHIMA), Certified Coding Specialist - Physican based (CCS-P) - American Health Information Management Association (AHIMA), Certified in Healthcare Compliance (CHC) - Health Care Compliance Association (HCCA), Certified Professional Coder (CPC) - American Academy of Professional Coders (AAPC), Certified Professional Coder - Hospital (CPC-H) - American Academy of Professional Coders (AAPC), Registered Health Information Administrator (RHIA) - American Health Information Management Association (AHIMA), Registered Health Information Technician (RHIT) - American Health Information Management Association (AHIMA)

Work Experience: Medical Billing/Coding (3 Years)

Grade

C13

Salary Range

$68,100.00 - $105,500.00 / Annually