Manager, W&E Professional Coding
Core
Leading a team of Certified Coding Analysts to conduct medical claim reviews and coding audits for payment integrity, identifying billing errors, waste, abuse, and fraud.
Role type
Manager, Waste & Error Certified Coding
Builds
Payment integrity outcomes through accurate coding audits and process improvements
Domain
Healthcare / Medical Billing & Coding
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure | physical/clinical work
Required skills
Medical coding (CPT, HCPCS, ICD-10), Claims review, Auditing, People leadership, Performance management, Compliance knowledge, Data analysis, Process improvement, Stakeholder communication
Preferred skills
Medicaid auditing, Reconsiderations and appeals, Fraud waste abuse (FWA) experience, EncoderPro, Change management
Technologies
Microsoft Excel, Word, EncoderPro
Responsibilities
Lead, coach, and develop a team of Certified Coding Analysts; Provide operational oversight for medical record reviews and coding audits; Establish and monitor quality review processes; Develop and monitor KPIs for productivity and quality; Partner with Medical Directors, Legal, and Compliance on complex issues.
Seniority
Manager, people leadership & operational oversight