BARROW BRAIN AND SPINE

JOB DESCRIPTION

JOB TITLE: Quality Assurance Coding Manager

DEPARTMENT: Business Office

REPORTS TO: Director of Revenue Cycle / Chief Operating Officer

FLSA STATUS: Exempt

JOB SUMMARY: The Quality Assurance Coding Manager, under the direction of the Director of Revenue Cycle is responsible for managing the day-to-day operations of the Coding team and all aspects of the quality assurance program for medical coding processes, ensuring accuracy, compliance, and optimization within the coding function. This role focuses on developing, implementing, and monitoring coding QA policies, performing audits, managing a team of coding auditors and trainers, and collaborating with other departments to imp rove coding accuracy, compliance, and efficiency.

JOB DUTIES & RESPONSIBILITIES:

• Manages assigned staff to ensure the performance of tasks are completed in an efficient and professional manner.

• Serves as a resource to staff by answering questions and assisting with problems related to coding opportunities.

• Assists Director of Revenue Cycle and COO with preparing and presenting reports as needed.

• Supports and maintains a work environment that embodies professional excellence, teamwork, integrity, and confidentiality.

• Demonstrate a strong knowledge of insurance carrier administrative policies including Medicare, Medicaid and Commercial insurances.

• Responsible for management of staff including recruitment, training, coaching, discipline and performance appraisals.

• Performs other duties and tasks as assigned. Quality Assurance Program Development and Implementation

• Design and establish a comprehensive quality assurance program for medical coding, including policies, procedures, and best practices geared towards Neurosurgery.

• Develop and maintain quality control guidelines to ensure compliance with regulatory standards, payer policies, and internal procedures.

• Implement a structured QA review process to assess coding accuracy, completeness, and consistency for providers and coding personnel. Auditing and Compliance

• Oversee and conduct coding audits on a regular basis to ensure coding accuracy and regulatory compliance.

• Review and assess coding documentation for accuracy in adherence to CPT, ICD -10-CM, HCPCS, and payer guidelines.

• Monitor and report on audit findings, identifying trends and areas for improvement.

• Ensure the team stays updated on regulatory changes, payer requirements, and compliance protocols. Team Management and Development

• Recruit, train, and manage a team of coding auditors and trainers, establishing clear expectations and performance goals

• Conduct regular team meetings to discuss QA metrics, process improvements, and regulatory updates.

• Foster a collaborative team culture focused on continuous improvement, professional growth, and knowledge-sharing.

• Provide feedback, coaching, and development plans to team members to enhance their skills and effectiveness.

Process Improvement and Optimization

• Identify coding process inefficiencies and work with cross-functional teams to develop and implement solutions.

• Collaborate with coding, billing, and clinical departments to streamline processes and optimize workflows.

• Use audit findings and quality metrics to recommend training or process changes aimed at reducing coding errors and improving revenue capture.

Reporting and Analysis

• Prepare and present regular QA reports, including audit findings, trends, quality scores, and action plans, to senior management and Chief Operating Officer.

• Use data analytics to identify patterns of coding errors and prioritize areas for improvement and training.

• Track and analyze key performance indicators (KPIs) related to coding quality and compliance.

Training and Education

• Develop and deliver ongoing training programs to ensure coders stay informed about coding updates, regulations, and best practices.

• Collaborate with clinical documentation specialists to provide education that enhances coding and documentation quality.

• Develop and distribute QA-related materials, manuals, and resources to support coder training and improvement.

PERFORMANCE REQUIREMENTS

• Excellent oral, written and telephone communication skills, along with tact, diplomacy, and strong customer service orientation.

• Reports to work regularly without undue tardiness.

• Works independently, without direct supervision.

• Prioritizes work activities for team and self to achieve department goals.

• Completes work accurately and in a timely manner.

• Maintains effective working relationships with physicians, administration, patients and other staff members. • Strong analytical and problem solving skills

• Proven ability to manage multiple projects concurrently.

• Maintains strict confidentiality regarding patient and practice information.

TYPICAL PHYSICAL DEMANDS:

• Prolonged sitting, standing, some bending, stooping and stretching and/or walking.

• Eye-hand coordination and manual dexterity sufficient to operate a computer keyboard, photocopier, fax machine, telephone, calculator, and other office equipment.

• Normal range of hearing and vision to record, prepare, and communicate appropriate reports.

EDUCATION & EXPERIENCE

• CPC, Preferred Neurosurgery experience

• High School Diploma or G.E.D. required. Bachelor’s Degree preferred

• Five+ years of full cycle medical billing experience required

• Previous surgical specialty experience required, preferably neurosurgery.

• Minimum of three years in a manager/supervisory role required.

• Two years coding (CPT, ICD-10, Modifiers) knowledge and experience preferred.

• Experience with EMR systems required Centricity (Athena Practice) a plus.

• Knowledge of HIPAA required

• Knowledge of medical records and transcription practices, standards and practices preferred