Boston Medical Center (BMC)
Manager, Professional Billing Coding Operations - Remote
Boston Medical Center (BMC), Boston, Massachusetts, us, 02298
Manager, Professional Billing Coding Operations - Remote
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Manager, Professional Billing Coding Operations - Remote
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Boston Medical Center (BMC) . Overview
Boston Medical Center (BMC) is a network of support and care that serves the needs of hundreds of thousands of people each year. It is the largest and busiest provider of trauma and emergency services in New England and the primary teaching affiliate of Boston University School of Medicine. The hospital is the largest safety-net hospital in New England and is involved in community-based care. The Role supports the Coding and Education Department and reports to the Director, PB Coding Operations. Responsibilities
Responsible for the operational functions of the Professional Billing (PB) Coding Operations team for BUMG. Validate the accuracy of CPT, HCPCS and diagnosis code assignments by coders, physicians, and non‑physician practitioners. Collaborate with revenue cycle stakeholders to understand denials, perform root cause analysis, and provide feedback to providers. Supervise professional billing coding staff and partner with the Coding Education Team to identify coding trends and develop provider feedback and education. Review coding denials to resolve issues, identify trends, and provide feedback. Perform quality assurance reviews of inpatient and outpatient records to assess training program effectiveness and coder performance. Provide in-service training and updates on coding changes to staff. Direct coding operations to ensure organizational goals are met and compliance with payer guidelines. Support coding-related RAC and external reviews and address denials related to coding. Essential Responsibilities / Duties
Coding support: Review patient records, abstract diagnoses and procedures, and code using ICD-10-CM, CPT-4/HCPCS; use reference materials to ensure accurate coding for billing. Sequence diagnoses and procedures per ICD-10-CM, CPT-4, UHDDS; consult medical staff to clarify documentation as needed. Maintain productivity standards and serve as contact for coders regarding missing information for accurate billing. Maintain knowledge of coding credentials through ongoing education. Assist in orienting new personnel and monitor coding queues. Perform routine chart audits, respond to coding questions, and ensure accurate billing. Provide continual coding updates and research coding issues; ensure compliance with Official Coding Rules and payer guidelines. General
Manage day-to-day operations of the PB Coding Operations Team, including mentoring coders. Recruit, train, evaluate, and discipline personnel as needed; establish staffing and workloads. Assist with coding professional claims; conduct quality reviews; evaluate documentation quality; initiate and monitor queries. Provide training to clinicians, coders, and Revenue Cycle staff on ICD/CPT/HCPCS guidelines and documentation requirements. Develop strategies to improve efficiency and coding performance; track accuracy and benchmarking. Participate in coding and reimbursement meetings; maintain HIPAA confidentiality and compliance. Maintain knowledge of ICD-10 and CPT classifications and coding trends; identify opportunities for process improvements. Education & Experience
Education: Bachelor’s degree or equivalent combination of education and experience. Certificates, Licenses, Registrations: CPC – Certified Professional Coder. Experience: At least five years of coding experience with ICD-10-CM and CPT-4; acute care hospital experience; minimum of three years management experience; experience with claim edits and denials preferred. Knowledge & Skills: Strong command of ICD-10-CM and CPT-4/HCPCS coding conventions (including E&M), knowledge of medical terminology, anatomy, physiology, and pathology; experience teaching coding to staff; strong organizational and multi-tasking abilities; strong HIPAA compliance; familiarity with payer claim edits and denials; ability to mentor and lead teams. Equal Opportunity
Equal Opportunity Employer/Disabled/Veterans Job details
Seniority level: Mid-Senior level Employment type: Full-time Job function: Management Industries: Hospitals and Health Care
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Join to apply for the
Manager, Professional Billing Coding Operations - Remote
role at
Boston Medical Center (BMC) . Overview
Boston Medical Center (BMC) is a network of support and care that serves the needs of hundreds of thousands of people each year. It is the largest and busiest provider of trauma and emergency services in New England and the primary teaching affiliate of Boston University School of Medicine. The hospital is the largest safety-net hospital in New England and is involved in community-based care. The Role supports the Coding and Education Department and reports to the Director, PB Coding Operations. Responsibilities
Responsible for the operational functions of the Professional Billing (PB) Coding Operations team for BUMG. Validate the accuracy of CPT, HCPCS and diagnosis code assignments by coders, physicians, and non‑physician practitioners. Collaborate with revenue cycle stakeholders to understand denials, perform root cause analysis, and provide feedback to providers. Supervise professional billing coding staff and partner with the Coding Education Team to identify coding trends and develop provider feedback and education. Review coding denials to resolve issues, identify trends, and provide feedback. Perform quality assurance reviews of inpatient and outpatient records to assess training program effectiveness and coder performance. Provide in-service training and updates on coding changes to staff. Direct coding operations to ensure organizational goals are met and compliance with payer guidelines. Support coding-related RAC and external reviews and address denials related to coding. Essential Responsibilities / Duties
Coding support: Review patient records, abstract diagnoses and procedures, and code using ICD-10-CM, CPT-4/HCPCS; use reference materials to ensure accurate coding for billing. Sequence diagnoses and procedures per ICD-10-CM, CPT-4, UHDDS; consult medical staff to clarify documentation as needed. Maintain productivity standards and serve as contact for coders regarding missing information for accurate billing. Maintain knowledge of coding credentials through ongoing education. Assist in orienting new personnel and monitor coding queues. Perform routine chart audits, respond to coding questions, and ensure accurate billing. Provide continual coding updates and research coding issues; ensure compliance with Official Coding Rules and payer guidelines. General
Manage day-to-day operations of the PB Coding Operations Team, including mentoring coders. Recruit, train, evaluate, and discipline personnel as needed; establish staffing and workloads. Assist with coding professional claims; conduct quality reviews; evaluate documentation quality; initiate and monitor queries. Provide training to clinicians, coders, and Revenue Cycle staff on ICD/CPT/HCPCS guidelines and documentation requirements. Develop strategies to improve efficiency and coding performance; track accuracy and benchmarking. Participate in coding and reimbursement meetings; maintain HIPAA confidentiality and compliance. Maintain knowledge of ICD-10 and CPT classifications and coding trends; identify opportunities for process improvements. Education & Experience
Education: Bachelor’s degree or equivalent combination of education and experience. Certificates, Licenses, Registrations: CPC – Certified Professional Coder. Experience: At least five years of coding experience with ICD-10-CM and CPT-4; acute care hospital experience; minimum of three years management experience; experience with claim edits and denials preferred. Knowledge & Skills: Strong command of ICD-10-CM and CPT-4/HCPCS coding conventions (including E&M), knowledge of medical terminology, anatomy, physiology, and pathology; experience teaching coding to staff; strong organizational and multi-tasking abilities; strong HIPAA compliance; familiarity with payer claim edits and denials; ability to mentor and lead teams. Equal Opportunity
Equal Opportunity Employer/Disabled/Veterans Job details
Seniority level: Mid-Senior level Employment type: Full-time Job function: Management Industries: Hospitals and Health Care
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