Position Summary: The Manager of Coding & Revenue Integrity is responsible for the performance, accuracy, and compliance of hospital and professional coding, charge capture processes, and chargemaster (CDM) governance across the organization.
This role provides operational leadership for hospital-based (HB) and professional-based (PB) coding functions, ensuring accurate code assignment, timely coding completion, and compliance with all regulatory and payer requirements. The Manager oversees revenue integrity activities, including charge capture processes and chargemaster (CDM) governance, supporting accurate reimbursement across all organizational service lines and reimbursement methodologies, including Critical Access Hospital (CAH), Rural Health Clinic (RHC), Emergency Medical Services (EMS), hospital-based (HB), professional-based (PB), and other provider-based services as applicable.
Working in a Critical Access Hospital (CAH) environment, this role plays a critical part in optimizing reimbursement, reducing denials, and preventing revenue leakage. The Manager partners closely with clinical departments, Patient Access, and Revenue Cycle leadership to improve documentation, coding accuracy, and charge capture workflows, driving measurable improvements in financial performance and compliance.
Essential Functions (Responsibilities/Accountabilities):Coding Operations (HB & PB)- Oversee coding operations supporting multiple care settings and reimbursement methodologies, including CAH, RHC, EMS, hospital-based, professional-based, and other provider-based services as applicable
- Monitor coding productivity, accuracy, and turnaround times, implementing improvements as needed
- Ensure coding practices align with regulatory requirements, payer guidelines, and organizational policies
Revenue Integrity & Charge Capture- Oversee charge capture processes across departments to ensure services provided are accurately documented and billed
- Identify and resolve charge capture issues, including missing charges, incorrect coding, and workflow gaps
- Collaborate with clinical departments to improve documentation practices that support accurate coding, charge capture, and reimbursement
Chargemaster (CDM) Governance- Maintain and oversee the hospital chargemaster, ensuring accuracy, completeness, and compliance with regulatory requirements
- Coordinate implementation of annual regulatory coding updates, CPT/HCPCS changes, and reimbursement modifications impacting the chargemaster
- Review and update CDM entries, including CPT/HCPCS codes, revenue codes, and pricing alignment
- Partner with Finance and Revenue Cycle leadership on CDM strategy and maintenance processes
Government Reimbursement & Specialized Billing Support- Support coding and revenue integrity processes across CAH, RHC, EMS, and other specialized reimbursement methodologies
- Monitor regulatory and payer changes impacting coding and reimbursement and coordinate operational implementation
- Partner with Revenue Cycle leadership to address reimbursement risks associated with specialized billing programs
Denials Prevention & Revenue Optimization- Analyze coding and charge-related denials to identify root causes and implement corrective actions
- Partner with Revenue Cycle teams to reduce denials and improve clean claim rates
- Support initiatives to improve reimbursement accuracy and reduce revenue leakage
Auditing, Compliance & Education- Conduct coding and charge capture audits to ensure compliance and identify improvement opportunities
- Provide education and training to coding staff, clinical departments, and other stakeholders
- Coordinate internal and external coding audit activities and monitor corrective action plans to ensure sustained compliance
- Ensure audit readiness and compliance with all applicable regulatory requirements
Data, Reporting & Performance Management- Monitor and report key performance metrics, including coding accuracy, productivity, denial trends, and charge capture performance
- Use data to identify trends, risks, and opportunities for improvement
- Provide regular reporting to Revenue Cycle leadership
Staff Leadership & Development- Recruit, train, and develop coding and revenue integrity staff
- Establish performance expectations and accountability measures
- Provide coaching, feedback, and ongoing development to staff
Workflow Improvement & Standardization- Evaluate and improve coding and charge capture workflows to enhance efficiency and accuracy
- Develop and maintain standardized coding, documentation, charge capture, and revenue integrity policies and procedures
- Implement best practices for coding, documentation, and revenue integrity processes
Collaboration & Cross-Functional Alignment- Partner with providers, clinical departments, Patient Access, Finance, and the Central Business Office to improve documentation quality, reduce reimbursement risk, and strengthen end-to-end revenue cycle performance.
The responsibilities listed above are not all-inclusive; other activities may be required in support of the hospital's goals and objectives.
Position Requirements:Education- Associate's degree required, Bachelor's degree in Health Information Management, Healthcare Administration, or related field preferred
- Relevant coding certifications required (e.g., RHIT, RHIA, CCS, CPC)
Experience- 5+ years of experience in hospital and/or professional coding, revenue integrity, or charge capture
- 2-3 years of leadership or supervisory experience required
- Experience in hospital-based (HB) and professional-based (PB) coding required
- Experience supporting diverse reimbursement methodologies, including Critical Access Hospital (CAH), Rural Health Clinic (RHC), Emergency Medical Services (EMS), and other provider-based services preferred
- Demonstrated experience improving coding accuracy, reducing denials, or enhancing charge capture processes
Regulatory & Technical Knowledge- Comprehensive knowledge of ICD-10-CM/PCS, CPT, and HCPCS coding guidelines
- Strong understanding of Medicare, Medicaid, commercial payer requirements, and reimbursement methodologies impacting hospital, professional, CAH, RHC, EMS, and provider-based services
- Familiarity with NCCI edits, medical necessity requirements, LCD/NCD guidance, and government reimbursement regulations
- Knowledge of chargemaster (CDM) structure, maintenance, and pricing alignment
- Understanding of revenue integrity principles, including charge capture, documentation alignment, and compliance requirements
- Familiarity with audit processes, coding compliance, and regulatory standards.
Systems, Data & Analytics- Experience working with EHR systems, coding tools, encoder software, and billing systems
- Ability to analyze coding, denial, and charge capture data to identify trends and improvement opportunities
- Proficiency in reporting tools and data analysis (Excel or equivalent)
Leadership & Professional Competencies- Strong operational leadership skills with the ability to manage coding workflows and revenue integrity processes
- Demonstrated ability to lead, develop, and mentor coding and revenue integrity staff
- Excellent communication skills, with the ability to collaborate with clinical, financial, and operational stakeholders
- Ability to drive process improvement, standardization, and accountability across departments.
- High level of integrity, accuracy, and attention to detail
Pay Range:Pay ranges from $69,903k to $111,844k (rate of pay is based on applicable years of experience)Horizon Health is committed to caring not only for our patients, but for our staff as well. We offer you an extensive total compensation and benefits package. As an employee of Horizon Health, your benefits include a competitive salary, medical, dental and vision insurance, Employee 403(b), health savings account with Company match, as well as Vacation, Sick and Paid Holidays.
Intrigued? Don't wait, apply today. We are actively reviewing applicants for the Coding and Revenue Integrity Manager. Be part of an organization that is dedicated to the growth and development of its colleagues. Here at Horizon Health, our employees speak for themselves. Join our family & begin an incredible career!
