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 Lead, mentor, coach, and develop a high-performing team of medical coders, fostering a culture of excellence, accountability, and continuous improvement.

- 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 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.