Job Description:
We are seeking an experienced Client Success- Coding Manager with expertise in medical coding, auditing, and compliance to oversee client relationships, coding operations, and revenue cycle optimization. This role requires a deep understanding of CPT, ICD-10, HCPCS, payer policies, and denial management, ensuring that clients receive best-in-class coding services and compliance support.
The ideal candidate will have a strong background in medical coding, compliance audits, RCM workflow optimization, and payer regulations, along with exceptional client relationship management skills.
Key Responsibilities:
Client Success & Relationship Management:
- Serve as the primary point of contact for clients, ensuring smooth communication and resolution of coding-related concerns.
- Develop and implement client engagement strategies to maximize satisfaction, retention, and revenue growth.
- Conduct Quarterly Business Reviews (QBRs) and compliance audits to drive process improvements.
- Identify upsell and cross-sell opportunities within client accounts to expand coding service offerings.
Medical Coding & Compliance Oversight:
- Ensure adherence to ICD-10, CPT, HCPCS, and payer-specific guidelines across multiple specialties.
- Conduct coding audits, documentation reviews, and risk assessments to improve coding accuracy and compliance.
- Monitor denial trends, coding discrepancies, and revenue leakage, implementing corrective actions as needed.
- Stay up to date with Medicare, Medicaid, and commercial payer regulations, ensuring regulatory compliance.
- Provide training and education to clients and internal teams on evolving coding guidelines and best practices.
Revenue Cycle & Denial Management:
- Optimize coding workflows, ensuring efficient charge capture and clean claim submission.
- Collaborate with billing, AR, and denial management teams to reduce denials, enhance revenue recovery, and improve coding accuracy.
- Track key performance indicators (KPIs) such as clean claim rates, denial rates, coding accuracy, and compliance scores.
- Drive coding automation initiatives to improve operational efficiency and minimize manual errors.
Cross-Functional Collaboration & Leadership:
- Work closely with operations, compliance, and technology teams to refine and enhance coding service offerings.
- Lead and mentor onshore and offshore coding teams, ensuring high performance and adherence to compliance standards.
- Partner with business development teams to support client onboarding, process improvement initiatives, and contract renewals.
- Act as an RCM Subject Matter Expert (SME) in internal strategy discussions and client engagements.
Required Qualifications:
- Bachelor's degree in Healthcare Administration, Business, or a related field (Master's preferred).
- 7+ years of experience in medical coding, auditing, and revenue cycle management in a leadership role.
- Certification required: CPC, CCS, or equivalent (AHIMA or AAPC certification preferred).
- Strong understanding of payer policies, claims processing, medical necessity guidelines, and risk adjustment methodologies.
- Experience in coding audits, denial resolution, and revenue integrity initiatives.
- Proficiency in RCM platforms, EHR/EMR systems (Epic, Meditech, Paragon, etc.).
- Experience managing onshore/offshore coding teams and handling multi-client engagements.
- Strong analytical, problem-solving, and negotiation skills with the ability to translate data into actionable insights.
- Willingness to travel as needed(30-50%).
