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Boston Medical Center

Senior Manager Coding IP OP

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 ...

Boston Medical Center

Senior Manager Coding IP OP

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 ...

Pennant Services

Denials Management Specialist

$18.50 - $24.50/hr

... Contractor (SMRC), Recovery Audit Contractor (RAC), Medicare Administrative Contractor (MAC ... Comfortable working independently in a remote environment while maintaining strong collaboration ...

Careoregon

Payment Integrity Analyst

Review published Centers for Medicare and Medicaid Services (CMS)/Recovery Audit Contractor (RAC) topics for viability of Care Oregon's paid claims. * Review vendor overpayment suggestions for ...

Careoregon

Payment Integrity Analyst

OR · On-site +1

Review published Centers for Medicare and Medicaid Services (CMS)/Recovery Audit Contractor (RAC) topics for viability of Care Oregon's paid claims. * Review vendor overpayment suggestions for ...

J29

Medical Reviewer, RN/CPC

$70K - $85K/yr

Remote Salary: $70,000-85,000 annually, based on years of experience J29, Inc. (J29) has been ... determined by Recovery Audit Contractors (RACs). They apply Medicare policies and guidelines ...

J29 Inc.

Medical Reviewer, RN Coder

Millersville, MD · On-site +1

$70K - $85K/yr

Remote Salary: $70,000-85,000 annually, based on years of experience About J29 J29, Inc. (J29) has ... determined by Recovery Audit Contractors (RACs). They apply Medicare policies and guidelines ...

J29, Inc

Medical Reviewer, Registered Nurse

$70K - $85K/yr

Remote Salary: $70,000-85,000 annually, based on years of experience About J29 J29, Inc. (J29) has ... determined by Recovery Audit Contractors (RACs). They apply Medicare policies and guidelines ...

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Remote Recovery Audit Contractor information

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How much do remote recovery audit contractor jobs pay per year?

As of Sep 2, 2026, the average yearly pay for remote recovery audit contractor in the United States is $72,633.00, according to ZipRecruiter salary data. Most workers in this role earn between $47,000.00 and $98,500.00 per year, depending on experience, location, and employer.

What is a remote recovery audit contractor?

Remote Recovery Audit Contractors are professionals or firms hired to review financial transactions, such as medical claims or vendor payments, to identify and recover overpayments or incorrect payments. They work remotely, using specialized software and data analysis techniques to audit large volumes of records for potential errors or discrepancies. These contractors are commonly used by healthcare organizations, insurance companies, and government agencies to ensure compliance and recover lost funds. Their findings can help organizations improve their payment processes and prevent future mistakes.

What skills and qualifications are needed to thrive as a remote recovery audit contractor?

To thrive as a Remote Recovery Audit Contractor, you need expertise in healthcare claims auditing, knowledge of Medicare/Medicaid regulations, and a relevant degree such as in health information management or accounting. Familiarity with audit software, medical coding systems (like ICD-10 and CPT), and data analysis tools is typically required. Strong analytical thinking, attention to detail, and effective written communication are essential soft skills for identifying discrepancies and reporting findings. These skills are crucial for ensuring accuracy in claim reviews, detecting improper payments, and supporting compliance in remote healthcare environments.

What are the main challenges faced by a remote recovery audit contractor and how can they be overcome?

Remote Recovery Audit Contractors often face challenges such as accessing and analyzing large volumes of healthcare or financial data from diverse sources, ensuring compliance with privacy regulations, and maintaining clear communication with clients and team members. To overcome these, it's important to develop strong organizational and analytical skills, stay updated on industry regulations, and leverage secure collaboration tools. Regular virtual meetings and proactive communication also help in aligning with stakeholders and resolving discrepancies efficiently.

What is the difference between Remote Recovery Audit Contractor vs Remote Healthcare Auditor?

AspectRemote Recovery Audit ContractorRemote Healthcare Auditor
CredentialsCPAR certification often preferredCPAR, CHAP, or similar healthcare-specific certifications
Work EnvironmentRemote, contract-based, healthcare industryRemote, healthcare industry focus
Employer & Industry UsageHealthcare payers, government agencies, insurance companiesHospitals, healthcare providers, insurance companies
Primary FocusIdentifying and recovering overpaid healthcare claimsAuditing healthcare records and billing for compliance

The main difference is that a Remote Recovery Audit Contractor primarily focuses on recovering overpaid healthcare claims through audits, while a Remote Healthcare Auditor reviews healthcare records and billing for compliance and accuracy. Both roles require healthcare industry knowledge and certifications but serve different functions within healthcare finance and compliance.

How are remote recovery audit contractors paid?

Remote recovery audit contractors are typically paid on a performance-based basis, earning a percentage of the recovered funds or overpayment amounts they identify. Payments are often made after successful recovery and may be structured as commissions or fees, depending on the contract terms and organization policies.
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Cities with the most Remote Recovery Audit Contractor job openings:

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States with the most job openings for Remote Recovery Audit Contractor jobs include:

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Remote Recovery Audit Contractor jobs near you
Infographic showing various Remote Recovery Audit Contractor job openings in the United States as of August 2026, with employment types broken down into 2% As Needed, 76% Full Time, 19% Part Time, and 3% Contract. Highlights an 96% Physical, 1% Hybrid, and 3% Remote job distribution, with an average salary of $72,633 per year, or $34.9 per hour.

Senior Manager Coding IP OP

Boston Medical Center

Remote

Full-time

Medical, Dental, Vision, Retirement, PTO

This job post has expired 3 days ago. Applications are no longer accepted.

Boston Medical Center rating

7.0

Company rating: 7.0 out of 10

Based on 109 frontline employees who took The Breakroom Quiz

512th of 1,064 rated hospitals

Job description

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:
  • 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.
  • Develops, implements, and maintains standardized coding guidelines for inpatient and outpatient services, integrating updates from the Official Coding Guidelines and Coding Clinic.
  • 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.
  • 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.
  • Conducts routine, structured data quality reviews of coded medical records to evaluate accuracy, consistency, and adherence to national documentation and coding requirements.
  • 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.
  • 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.
  • 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.
  • 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 duties and responsibilities required).
JOB REQUIREMENTS
REQUIRED EDUCATION AND EXPERIENCE:
  • Bachelor's Degree in Health Information Management or a related field, and a minimum of five years of acute care hospital coding experience with ICD-10-CM/PCS, of which at least three years must be healthcare management experience; or an equivalent combination of education and experience.

PREFERRED EDUCATION AND EXPERIENCE:
  • Five years of healthcare management experience in an academic medical setting or trauma center, with preferred experience utilizing Current Procedural Terminology (CPT-4).

CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED:
  • Certified Coding Specialist (CCS) credential

CERTIFICATES, LICENSES, REGISTRATIONS PREFERRED:
  • Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) credential

KNOWLEDGE, SKILLS & ABILITIES (KSAs):
  • Reimbursement Methodologies: Extensive knowledge of hospital inpatient and outpatient reimbursement methodologies, including DRG systems such as CMS DRGs, AP-DRGs, and APR-DRGs.
  • Clinical Knowledge: In-depth knowledge of medical terminology, anatomy, physiology, and pathology as they relate to accurate clinical coding and reimbursement assignment.
  • Coding Systems: Advanced, fluent knowledge of ICD-10-CM/PCS and CPT coding systems, including Official Coding Guidelines and regulatory coding conventions.
  • Systems Proficiency: Strong understanding of health information systems, data integrity principles, and electronic health record (EHR) workflows, alongside proficiency in Microsoft Office applications.
  • Analytical Skills: Ability to interpret complex clinical and coding data to isolate systemic issues, resolve discrepancies, and apply regulatory and organizational policies appropriately.
  • Time Management: Strong organizational and time management skills, including the ability to prioritize competing operational demands, manage multiple deliverables, and meet tight compliance deadlines.
  • Leadership & Coaching: Ability to provide structured guidance, coaching, mentoring, and informal leadership to coding staff to actively model best practices in coding accuracy and compliance.
  • Regulatory Compliance: Ability to maintain strict confidentiality and ensure complete compliance with HIPAA and other privacy regulations when handling sensitive health information

Compensation Range:
$97,500.00- $141,500.00
This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensures as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, BMCHS offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), discretionary annual bonuses and merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family well-being.
NOTE: This range is based on Boston-area data, and is subject to modification based on geographic location.
Equal Opportunity Employer/Disabled/Veterans
According to the FTC, there has been a rise in employment offer scams. Our current job openings are listed on our website and applications are received only through our website. We do not ask or require downloads of any applications, or "apps" job offers are not extended over text messages or social media platforms. We do not ask individuals to purchase equipment for or prior to employment.

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About Boston Medical Center

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Boston Medical Center (BMC) is more than a hospital. It's a network of support and care that touches the lives of hundreds of thousands of people in need each year. It is the largest and busiest provider of trauma and emergency services in New England. Emphasizing community-based care, BMC is committed to providing consistently excellent and accessible health services to all-and is the largest safety-net hospital in New England. The hospital is also the primary teaching affiliate of the nationally ranked Boston University School of Medicine (BUSM) and a founding partner of Boston HealthNet - an integrated health care delivery systems that includes many community health centers. Join BMC today and help us achieve our Vision 2030 which is a long-term goal to make Boston the healthiest urban population in the world.

Industry

Hospitals

Company size

1,001 - 5,000 Employees

Headquarters location

Boston, MA, US

Year founded

1996

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