Senior Manager – RCM – Coding Operations

Role Overview

• Provides operational and people leadership to a team of direct reports, including coaching, performance management, workload prioritization, and professional development, while fostering a culture of accountability and continuous improvement.
• Partners with Regional Senior Coding Operations Managers to monitor daily coding edits and denial volumes, assigns workloads to internal staff and vendors, and evaluates team performance against established productivity and accuracy goals.
• Ensures adherence to coding guidelines and regulatory requirements by participating in quality and compliance audits, reviewing audit outcomes, and developing, implementing, and reporting on corrective action and remediation plans.
• Drives strategic and process improvement initiatives by contributing to the development and maintenance of coding edits and denials playbooks, workflows, and automation aimed at reducing charge lag, supporting timely filing, and improving clean claim rates.
• Supports business development and new client integrations by evaluating edits and denials performance post-go-live and providing clear, actionable summaries to regional leadership.
• Monitors, analyzes, and reports on edits and denials key performance indicators (KPIs); identifies trends and outliers; conducts root cause analysis; and develops data-driven workplans to address performance gaps.
• Collaborates cross-functionally with Clinical Documentation Improvement (CDI), RCM Quality Assurance, Information Technology, Finance, Regional Senior Leadership, and other Revenue Cycle Management (RCM) functions to align operational, quality, and financial objectives.
• Partners with Coding Quality and Education teams to support and deliver ongoing training and education for coders related to edits and denials.
• Applies deep expertise in coding edits, denials, and anesthesia coding standards (CPT, ICD-10, HCPCS, ASA) to ensure accurate, compliant coding and billing practices, including appropriate use of anesthesia modifiers and concurrency rules.
• Interprets and enforces Medicare, Medicaid, and Workers’ Compensation guidelines to support compliant billing, denial prevention, and revenue integrity.
• Utilizes Athena IDX or similar practice management and billing systems, along with data analytics tools such as Power BI and Excel, to monitor performance, analyze trends, and drive operational and process improvements.
• Works closely with analytics, IT, and RCM Accounts Receivable teams to design, implement, and enhance system edits, reporting, and tools that improve clean claim rates and overall revenue cycle performance.
• Maintains a holistic perspective in a complex and dynamic environment by demonstrating sound judgment, professionalism, adaptability, and strong problem-solving skills while effectively collaborating with diverse stakeholders and responding agilely to changing priorities.

Requirements

• Bachelor's degree in related field, or equivalent commensurate professional experience required.
• 4+ years of medical billing or revenue cycle management experience.
• Strong written and verbal communications skills.
• Comfortable learning new technology tools.
• Knowledgeable of drives of revenue cycle optimal performance and able to investigate and resolve complex claims and reimbursement challenges.
• Independent thinker with proven ability to perform detailed analysis, make decisions and provide recommendations to leadership using data.
• Enjoy working cross-functionally in a highly collaborative, virtual environment.
• Customer service and/or account management experience preferred.
• Experience in edits and denials management within an anesthesia billing environment required.
• Professional coding certification (I.e., CPC, CCS-P) required.

Benefits

• Eligible for an annual bonus
• Bonuses are awarded based on company and individual performance