The Physician Coding Manager oversees the daily operations of a medical coding department, ensuring that professional services provided by physicians are accurately translated into standardized codes for billing and compliance. Performs other related duties as necessary.

Core Responsibilities

• Departmental Oversight: Manage the daily workflow of the physician coding department. Oversee accurate assignment of CPT, HCPCS, and ICD-10-CM codes for physician services.

Compliance Management: Ensure compliance with:

• Centers for Medicare & Medicaid Services (CMS) regulations
• Office of Inspector General (OIG) guidelines
• American Medical Association (AMA) CPT guidance
• Monitor adherence to payer-specific policies (Medicare, Medicaid, commercial plans).
• Prevent and address upcoding, downcoding, and unbundling risks.

Performance Monitoring:

• Track KPIs such as:
  • Coding accuracy rate
  • DNFB (Discharged Not Final Billed) impact
  • Denial rates related to coding
  • Productivity benchmarks
• Generate dashboards for executive leadership.
• Identify financial risk areas related to coding.

Education & Training

· Educate physicians and APPs on:

• E/M documentation requirements
• Medical necessity
• Modifier usage
• Split/shared visits
• Incident-to billing

· Provide specialty-specific education sessions.

· Support new provider onboarding regarding documentation standards.

Audit Coordination:

· Develop and manage internal coding audit programs.

· Conduct routine and focused audits (E/M leveling, modifier usage, procedural coding).

· Track accuracy rates and implement corrective action plans.

· Coordinate external audits (RAC, MAC, commercial payer reviews).

· Present audit findings to executive leadership and providers.

Revenue Cycle Collaboration:

· Partner with Revenue Cycle, CDI, Compliance, and Finance teams.

· Monitor coding-related denials and implement denial prevention strategies.

· Ensure timely charge capture and reconciliation processes.

· Analyze reimbursement trends and coding impact on revenue.

Key Qualifications

• Education: A Bachelor’s degree in Health Information Management, Health Services Administration, or a related field is typically required or preferred.
• Experience: Generally requires 3-5 years of physician coding experience, with at least 2–3 years in a leadership or supervisory role (preferred).
• Certifications: Professional certification from AAPC or AHIMA is essential (or at least working towards). Common credentials include:
  • CPC (Certified Professional Coder)
  • CCS-P (Certified Coding Specialist – Physician-based)
  • RHIT (Registered Health Information Technician) or RHIA (Registered Health Information Administrator)