Manager PB Coding Denials Integrity - Medical Specialties

Accountabilities:: Lead and manage daily operations within the assigned professional billing coding denials and integrity function, ensuring activities align with broader organizational and revenue cycle objectives. Evaluate workflows and operational processes to improve efficiency, productivity, consistency, and adoption of standardized best practices across the mid-revenue cycle. Monitor compliance with regulatory requirements, accreditation standards, coding guidelines, and organizational policies while protecting the confidentiality of patient information and escalating potential compliance concerns appropriately. Establish and monitor key performance indicators (KPIs), analyze operational trends, and use data-driven insights to identify opportunities for improvement. Leverage healthcare technology, electronic health record systems, analytics tools, and revenue cycle solutions to improve decision-making and operational performance. Partner with clinical, IT, Compliance, Finance, and Revenue Cycle leaders to align processes, resolve issues, support regulatory compliance, and advance patient safety and financial integrity. Build and maintain effective relationships with key stakeholders across a matrixed organization, facilitating communication, problem-solving, and operational alignment. Lead and develop a team of professionals, including hiring, performance management, coaching, training, professional development, and career growth activities. Foster a culture of accountability, continuous improvement, collaboration, and financial responsibility across the team. Lead strategic operational initiatives, manage project timelines, and oversee system or workflow enhancements designed to improve effectiveness and scalability. Support the medical specialties portfolio across areas including laboratory, pathology, behavioral health, pediatrics, allergy and immunology, dermatology, gastroenterology, hepatology, infectious disease, endocrinology, nephrology, rheumatology, pulmonology, sleep medicine, maternal-fetal medicine, OB/GYN, reproductive endocrinology, and urogynecology. Requirements: Bachelor’s degree in Health Information Management, Healthcare Administration, or a related field, or equivalent professional experience. At least 8 years of experience in mid-revenue cycle operations, coding, Health Information Management (HIM), healthcare technology, or a related area, including 2+ years of leadership experience within a large integrated healthcare system. Current relevant industry certification from an approved accrediting body is required. Coding certification through AAPC or AHIMA is required, with dual certification preferred. Strong knowledge of professional and facility coding, HIM operational guidelines, revenue cycle workflows, third-party reimbursement programs, and applicable state and federal regulations. Working knowledge of national and local coverage decisions and coding classification systems, including ICD-10, CPT, and HCPCS. Strong analytical skills, with the ability to compile and interpret data from multiple sources, identify trends, recognize operational patterns, and translate findings into improvement opportunities. Strong understanding of EHR systems and revenue cycle technology, together with proficiency in Microsoft 365 applications including Teams, SharePoint, Word, Excel, PowerPoint, and Access. Demonstrated experience optimizing workflows, standardizing processes, managing resources, and improving operational effectiveness within complex healthcare environments. Proven ability to lead, coach, and develop teams while establishing clear expectations and fostering accountability and continuous improvement. Strong interpersonal and communication skills, with the ability to collaborate effectively with clinicians, finance professionals, IT teams, compliance stakeholders, and revenue cycle leaders. Strong problem-solving and critical-thinking abilities, with excellent attention to detail and the ability to manage competing priorities and deadlines. Ability to work effectively within a matrixed organization and build consensus across multiple departments. Willingness to travel when required by the role and to operate effectively in a standard office environment, including occasional lifting of up to 40 pounds. Benefits: Full-time position with a 40-hour workweek. Monday–Friday, first-shift schedule. Remote opportunity available for eligible candidates residing in approved U.S. states, including AL, AK, AR, AZ, DE, FL, GA, IA, ID, IL, IN, LA, KS, KY, ME, MI, MO, MS, MT, NC, ND, NE, NH, NM, NV, OH, OK, PA, SC, SD, TN, TX, UT, VA, WI, WV, and WY. Compensation range of $51.05–$76.60 per hour, with actual compensation based on qualifications, skills, relevant experience, and training. Potential premium pay, such as shift or on-call pay, depending on position requirements. Incentive pay for select positions and potential annual performance-based increases. Paid time off programs. Medical, dental, and vision coverage. Life insurance and short- and long-term disability benefits. Flexible Spending Accounts for eligible healthcare and dependent-care expenses. Adoption assistance and paid parental leave. Defined contribution retirement plans with employer matching and additional financial wellness programs. Educational assistance programs. Opportunities for professional development, career growth, and leadership development. Benefits eligibility may vary according to employment status.