Manager, Coding Denials at Healthrise in Location not listed

Healthrise is seeking a Manager of Coding Denials to lead the day-to-day performance of a coding team with a primary focus on identifying, resolving, and preventing coding-related denials across DRG, CPT, HCPCS, and ICD-10 coding. This role is ideal for an experienced coding professional ready to step into people leadership, combining hands-on coding and denials expertise with direct oversight of staff, workflow, and quality.

The Manager owns the coding denials function end to end, managing the intake, coding review, and resolution of coding-driven denials, and partnering with revenue cycle and appeals teams to reduce denial volume and recover revenue. The Manager also monitors broader productivity and quality metrics, coaches and develops coding staff, and serves as the first point of escalation for complex coding questions and documentation issues. This individual works closely with Clinical Documentation Integrity (CDI) staff and coordinates with third-party vendor coders assigned to the team to keep coding operations running smoothly and compliantly.

This role offers a clear path to grow into broader coding leadership, with direct exposure to department wide quality, compliance, and process improvement initiatives.

Duties and Responsibilities

Team Management and Development

• Knows, understands, incorporates, and demonstrates the Healthrise Core Values in all interactions with team members, clients, and stakeholders.
• Manages the daily workflow and assignment of coding queues to ensure productivity and turnaround targets are met.
• Conducts performance reviews and regular coaching and leads onboarding and training for new coding staff.
• Coordinates with third party coding vendor staff assigned to the team, monitoring day-to-day quality and SLA performance.
• Serves as a resource and mentor for staff navigating complex coding scenarios, building team capability over time.

Quality and Compliance

• Conducts regular quality audits of team coding accuracy across DRG, CPT, HCPCS, and ICD-10 assignment, providing feedback and coaching based on findings.
• Serves as the first point of escalation for complex coding questions, denials, or documentation queries raised by the team.
• Reviews coding related denials for accuracy and determines appropriate resolution, including code correction, appeal, or write off, and guides staff through similar determinations.
• Identifies trends contributing to denials or revenue variance within the team's work, tracking patterns by payer, DRG, or code family, and escalates findings to the Director of Coding.
• Partners with Clinical Documentation Integrity (CDI) staff to resolve documentation gaps affecting code assignment and query practices.
• Ensures team compliance with coding guidelines, payer requirements, and regulatory standards, staying current on relevant coding and billing updates.

Reporting and Continuous Improvement

• Maintains coding productivity and quality reporting and dashboards for the team, including denial volume, turnaround time, and resolution outcomes.
• Supports special projects such as CDM reviews, coding audits, or system implementations as assigned by the Director of Coding.
• Recommends workflow or process improvements to strengthen team accuracy, efficiency, and denial prevention.
• Performs other duties as assigned.

Qualifications

Required

• Active coding credential required, such as CCS, CCS-P, CPC, COC, CIC, RHIA, or RHIT (AHIMA or AAPC), or equivalent.
• Minimum 5 years of coding experience, including experience leading, mentoring, or informally supervising other coders.
• Strong working knowledge of DRG, CPT, HCPCS, and ICD-10 coding methodologies.
• Proficiency in Epic or comparable EHR/coding platforms.
• Strong written and verbal communication and coaching skills.
• Ability to manage multiple priorities and competing deadlines in a fast-paced environment.
• Completion of regulatory/mandatory certifications as required.
• Willingness and ability to travel to client or organizational sites as needed.

Preferred

• Bachelor’s degree in Health Information Management or related field.
• Certified Revenue Cycle Professional (CRCP) or equivalent industry certification.
• Experience managing or coordinating with offshore or third-party vendor coding staff.
• Experience supporting coding-related denial or audit response processes.

Physical Demands and Work Environment

• Work Environment: Operates in a variety of professional settings - corporate offices, client hospitals and health system campuses, remote home office, and travel environments. Must be comfortable adapting to new physical and technological environments quickly and frequently.
• Physical Demands: This is largely a sedentary role; however, employees may need to use keyboards, mouse, and other devices for typing, clicking, and navigating software systems.
• Schedule: Standard business hours with occasional flexibility required to support team escalations or client-driven deadlines.