Remote Risk Adjustment Coder Jobs in Gallatin, TN

Manager of Coding Operations

Position Details:
Full Time - Remote
Reports to the Coding Director
Must reside in one of the States listed below to be eligible for this position:

Arkansas    California    Kentucky
Massachusetts Nevada    New Mexico
Oregon     Utah     Tennessee
Texas     Wyoming

Job Summary:

• Reporting to the Coding Operations Director, the Coding Operations Manager is responsible for providing operational leadership and oversight of assigned coding functions across the organization, including inpatient, outpatient, observation, emergency department, ambulatory surgery, auditing, coding quality, coder education, contract coding resources, and other assigned coding operations.
• The Coding Operations Manager is accountable for ensuring coding services are performed in compliance with applicable federal and state laws, CMS regulations, Official ICD-10-CM/PCS Coding Guidelines, AHIMA Standards of Ethical Coding, AHA Coding Clinic guidance, CPT and HCPCS coding conventions, payer-specific billing requirements, and organizational policies.
• The Coding Operations Manager is responsible for achieving organizational coding quality, productivity, timeliness, and reimbursement accuracy benchmarks established by organizational leadership while supporting revenue integrity, compliance, and accurate reimbursement.

Duties and Responsibilities:

• Direct management responsibility over assigned coding operations, including inpatient, observation, outpatient, outpatient surgery, emergency department, ambulatory services, auditing, coding quality, contract coding resources, and other assigned coding functions. Ensures coding activities comply with organizational productivity, quality, compliance, and turnaround time expectations.
• Direct management responsibility over Discharged Not Final Billed (DNFB) accounts, coding work queues, unbilled claims, claim edits, and assigned revenue cycle work queues for inpatient, outpatient, emergency department, ambulatory surgery, wound care, laboratory, radiology, and ancillary services. Collaborates with Revenue Integrity and Patient Financial Services to resolve coding-related billing edits and reduce reimbursement delays.
• Collaborates with facility leadership, Revenue Integrity, Patient Financial Services, Clinical Documentation Integrity (CDI), Charge Description Master (CDM), ancillary departments, and clinical leaders to resolve coding discrepancies, conflicting documentation, charge capture issues, HCPCS assignment questions, and reimbursement concerns.
• Maintains extensive knowledge of National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), National Correct Coding Initiative (NCCI) edits, Medicare Claims Processing Manual requirements, commercial payer policies, and applicable federal and state regulatory requirements affecting coding and reimbursement.
• Responsible for achieving organizational coding quality and reimbursement accuracy goals through accurate assignment of ICD-10-CM, ICD-10-PCS, CPT®, HCPCS Level II, modifiers, APCs, MS-DRGs, APR-DRGs, and all applicable reimbursement methodologies in accordance with official coding guidance and payer requirements.
• Ensures federal, state, Medicare, Medicaid, Medicare Advantage, and commercial payer billing requirements are followed and that ongoing education, competency assessments, and regulatory updates are communicated to assigned coding staff.
• Responsible for scheduling staff, managing staffing assignments, approving leave requests, monitoring staffing coverage, coordinating contract coding resources as assigned, and ensuring operational continuity.
• Responsible for monitoring coding productivity, coding quality, turnaround times, accuracy, compliance, and performance metrics established by organizational leadership; provides coaching, mentoring, education, and corrective action as appropriate.
• Closely monitors Discharged Not Final Billed (DNFB) accounts, coding work queues, aging reports, and productivity dashboards to ensure timely claim submission and achievement of organizational turnaround time goals. Identifies trends and implements corrective actions to reduce coding-related delays.
• Ensures appropriate claim hold reasons are accurately assigned and documented after accounts enter DNFB reporting. Monitors hold reason trends and collaborates with operational leaders to resolve systemic barriers affecting timely billing.
• Ensures second-level coding reviews, quality audits, and charge reconciliation are performed for high-risk, high-dollar, or complex accounts, including but not limited to Interventional Radiology, Cardiac Catheterization, electrophysiology, trauma, transplant, and other designated service lines. Coordinates additional reviews as organizational priorities dictate.
• Maintains effective communication with hospital leadership, medical staff, Clinical Documentation Integrity (CDI), Revenue Integrity, Health Information Management (HIM), Patient Financial Services (PFS), and ancillary departments. Escalates documentation deficiencies, delinquent records, unresolved coding issues, and operational barriers in accordance with organizational policy.
• Monitors, trends, and analyzes coding queries, documentation clarification requests, physician response rates, and recurring documentation issues. Collaborates with CDI and physician leadership to improve documentation quality and reduce coding delays.
• Ensures coding staff appropriately holds accounts requiring essential clinical documentation, including but not limited to history and physical examinations, operative reports, pathology reports, procedure documentation, diagnostic reports, discharge summaries, and other required medical record components necessary for complete and accurate code assignment and compliant billing.
• Promotes a culture of collaboration, accountability, customer service, continuous improvement, and professional respect between corporate shared services, hospital leadership, physicians, clinical departments, and revenue cycle teams.
• Collaborates with HIM Operations Management and Revenue Cycle leadership to evaluate workflows, identify operational inefficiencies, implement process improvements, leverage automation technologies, and improve coding quality, productivity, reimbursement, and customer satisfaction.
• Develops, implements, maintains, and monitors coding-related policies, procedures, workflows, and standard operating practices to ensure compliance with CMS regulations, Official Coding Guidelines, AHIMA Standards of Ethical Coding, HIPAA requirements, payer policies, accreditation standards, and organizational compliance expectations.
• Demonstrates and enforces compliance with the AHIMA Standards of Ethical Coding, Official Coding Guidelines, organizational compliance policies, and all applicable federal and state regulations. Investigates potential compliance concerns and escalates issues through appropriate organizational channels.
• Maintains organizational Discharged Not Final Billed (DNFB) performance goals established by executive leadership through proactive workload management, staffing optimization, operational monitoring, and timely issue resolution.
• Ensures coding policies, regulatory requirements, compliance initiatives, internal controls, and organizational standards are implemented, communicated, monitored, and consistently followed across assigned coding operations.
• Leads and participates in corporate HIM, Coding, Revenue Cycle, Compliance, technology, regulatory, and operational improvement projects as assigned by the Coding Operations Director. Coordinates project implementation, change management, communication, education, and performance monitoring.
• Provides coding expertise and consultative support to Quality, Risk Management, Case Management, Clinical Documentation Integrity (CDI), Revenue Integrity, Finance, Compliance, Information Technology, Patient Financial Services, and other departments to support organizational initiatives, regulatory compliance, reimbursement optimization, and performance improvement.
• Collaborates with executive leadership, hospital leadership, medical staff, physician advisors, and corporate shared service departments to achieve strategic organizational goals and support enterprise-wide revenue cycle initiatives.
• Collaborates with HIM Operations Management, CDI leadership, Revenue Integrity, Compliance, and other stakeholders in the development, implementation, education, and ongoing evaluation of coding, documentation integrity, and revenue cycle policies and procedures.
• Monitors changes in federal and state regulations, CMS guidance, Official Coding Guidelines, accreditation standards, payer requirements, reimbursement methodologies, and industry best practices. Ensures timely implementation of operational changes and staff education resulting from regulatory updates.
• Maintains advanced knowledge of UB-04 billing requirements, revenue codes, claim editing systems, encoder software, electronic health records, charge capture processes, reimbursement methodologies, and revenue cycle technologies supporting compliant claim submission.
• Provides leadership over assigned coding quality initiatives, internal and external coding audits, coder education, competency assessments, contract coding vendor performance, corrective action planning, and other responsibilities assigned by the Coding Operations Director.

Knowledge, Skills and Abilities:

• Demonstrates extensive knowledge of Official ICD-10-CM/PCS Coding Guidelines, UHDDS, MS-DRG and APR-DRG assignment methodologies, OPPS, IPPS, APC reimbursement methodologies, Coding Clinic, CPT Assistant, HCPCS Level II, Medicare Claims Processing Manual, Medicare Benefit Policy Manual, National Correct Coding Initiative (NCCI) edits, National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), and commercial payer coding and reimbursement requirements.
• Proficient in Microsoft Office Suite (Word, Excel, Outlook, OneNote, PowerPoint), Microsoft Teams, encoder software, electronic health records, coding abstraction systems, auditing software, reporting tools, and other revenue cycle applications required to perform assigned responsibilities.
• Demonstrates excellent verbal, written, presentation, facilitation, conflict resolution, coaching, and interpersonal communication skills with the ability to effectively communicate with executive leadership, physicians, hospital leadership, coding professionals, and multidisciplinary teams.
• Demonstrates exceptional organizational, analytical, critical thinking, prioritization, and time management skills with the ability to effectively manage multiple competing priorities while consistently meeting established deadlines.
• Maintains extensive knowledge of anatomy, physiology, pathophysiology, pharmacology, disease processes, surgical procedures, diagnostic testing, medical terminology, clinical documentation, and reimbursement methodologies necessary to accurately assign diagnosis and procedure codes.

Work Experience, Education and Certifications:

• EDUCATION: Associate degree in Health Information Management, Health Information Technology, Nursing, Business Administration, Healthcare Administration, or a related healthcare field required. Bachelor's degree preferred. Equivalent combinations of education and progressively responsible coding leadership experience may be considered where permitted by organizational policy.
• EXPERIENCE: Minimum of five (5) years progressive acute care coding experience, including inpatient and outpatient coding. Three (3) or more years of coding leadership, supervisory, management, auditing, education, or project leadership experience preferred. Demonstrated experience managing coding productivity, coding quality, regulatory compliance, physician documentation issues, coding denials, revenue cycle initiatives, and operational improvement activities in a multi-facility healthcare environment is strongly preferred.
• CERTIFICATION/LICENSURE: Current RHIA, RHIT, CCS, or CPC credential from AHIMA or AAPC required. Additional specialty certifications including CDIP, CCDS, CPMA, CPCO, CRC, or CIRCC are preferred depending upon assigned responsibilities. Certification must be maintained in good standing throughout employment.
• SOFTWARE/HARDWARE: Demonstrated proficiency with 3M™ 360 Encompass, computer-assisted coding technologies, encoder systems, electronic health records, abstraction systems, auditing software, Microsoft Office applications, reporting tools, and other revenue cycle technologies. Experience with healthcare information systems preferred as applicable to assigned responsibilities.
• OTHER: Remote position. Employees must maintain a secure work environment that protects confidential patient information and complies with organizational information security, HIPAA Privacy Rule, and HIPAA Security Rule requirements. Employee must maintain reliable internet connectivity and be available during established business hours unless otherwise approved.

Travel Requirements:

• Expected travel of up to 30% to support hospital operations, leadership meetings, audits, education, regulatory readiness activities, project implementations, or other organizational business needs as determined by leadership.

Benefits:

• Competitive salary and benefits package.
• Opportunities for professional development and advancement.
• Supportive work environment with a collaborative team.
• Comprehensive healthcare coverage.
• Retirement savings plan.
• Paid time off and flexible scheduling options.
• Student loan repayment program.