[Hiring] Manager of HIM Profee Coding and Billing @Managed Resources

Role Description

The PB Coding Manager will oversee physician-based charging and billing, claim edits, payer appeals, provider audits, and coding quality while providing education to physicians across both clinic and hospital settings. This role requires extensive expertise in ICD-10-CM, CPT, and HCPCS Level II, along with the leadership skills to translate complex coding and payer requirements into actionable guidance for providers and coding teams.

Why This Role Matters:

• The PB Coding Manager provides the leadership and oversight needed to ensure physician services are coded accurately.
• Documentation supports medical necessity, claim edits and payer appeals are addressed appropriately.
• Coding practices remain aligned with ICD-10-CM, CPT, HCPCS, and regulatory requirements.
• Through ongoing provider audits, quality monitoring, and physician education, this leader helps identify documentation and coding gaps before they result in denials, lost revenue, or compliance risk.
• By partnering closely with providers, coding teams, auditors, and Revenue Cycle, the PB Coding Manager strengthens coding quality, supports appropriate reimbursement, improves billing outcomes, and promotes consistent, compliant practices across professional services.

Qualifications

• Certified Professional Coder (CPC) and Certified Professional Medical Auditor (CPMA) or Certified Evaluation and Management Coder (CEMC) required.
• Certified Coding Specialist – Physician Based (CCS-P) – AHIMA, RHIT or RHIA preferred.
• Valid California Driver’s license.
• Minimum (5) years of professional coding/auditing experience in a multispecialty healthcare setting for professional physicians claims to include evaluation and management services, ICD-10-CM diagnosis, HCPCS, and CPT coding for both inpatient and outpatient services, required.
• At least 5 years of experience in a supervisory or management role within the HIM Coding department preferred.
• In-depth knowledge of physician coding across specialties, E/M leveling, surgical coding, and modifier usage.
• Electronic Health Records (EHR): EPIC or equivalent enterprise EHR systems experience required.
• Experience with EPIC’s PB module (Professional Billing) strongly preferred.
• Coding and Billing Tools: Epic AI tools.
• Reporting & Analytics: Proficient in MS Excel (including pivot tables and VLOOKUPs), Word, and PowerPoint.
• Familiarity with reporting tools such as EPIC Clarity, Crystal Reports, Tableau, or Power BI a plus.
• Exposure to compliance software tools for audit management, and knowledge of OIG work plans, CMS NCCI edits, and payer policies.
• Revenue cycle knowledge of claims reimbursement associated with CMS LCD and NCD policies.
• Demonstrate excellent oral and written communication and presentation skills.
• Strong leadership, communication, interdepartmental collaborative relationships, and conflict resolution skills.
• Strong organizational skills and ability to prioritize multiple activities and objectives in given timelines.
• Creative problem-solving skills and able to work under pressure and continuous change.
• High attention to detail with excellent problem-solving abilities with the ability to interpret complex regulatory and payer guidelines.

Requirements

• Primary lead educator with sessions onsite and in electronic format for new and existing providers/clinicians.
• Oversee the professional coding of evaluation & management (E/M), surgical, and diagnostic services.
• Ensure accurate CPT, HCPCS, and ICD-10-CM code assignment by physicians for all PB claims.
• Monitor coding compliance with CMS, OIG, payer-specific guidelines, and organizational policy.
• Monitor un-billed, claim edit, and denial claim reviews ensuring revenue metrics do not exceed claims submissions.
• Coordinate monthly external professional audits with third-party vendors in collaboration with Compliance and the HIM Coding manager.
• Work closely with Revenue Integrity and Billing to streamline processes and resolve coding/billing issues.
• Maintain communication with leadership regarding trends, backlogs, and regulatory changes.
• Lead educational sessions with the coding team by conducting research on various regulatory sites and coding guidelines.
• Perform reviews of payer denials and analyze/track coding denials and documentation deficiency trends.
• Supervise, coach, and evaluate a team of professional coders and perform educational training of new and existing coding staff.
• Conduct internal and external auditing of coding staff team members.
• Coordinate with the facility HIM coding manager with professional surgical and obstetrical coding of claims.
• Ensure department goals and KPIs are met.

Benefits

• Medical, Dental, and Vision Insurance.
• Phone and Internet Stipend.
• Company-Paid Life Insurance.
• 401(k) Retirement Plan with Company Match.
• Paid Time Off.
• Seven Company-Observed Holidays.
• Two Floating Holidays for Personal Observance.
• Professional Development Opportunities.
• Employee Recognition Programs.
• Remote Work Environment.