Clinical Coding Manager

Job Summary

A company is looking for a Clinical Coding Manager to oversee clinical claims processing and payment integrity programs.

Key Responsibilities

• Manage prospective claim review queues and ensure compliance with clinical DRG coding
• Develop strategies for payment integrity team growth and process improvements
• Act as a Subject Matter Expert on clinical coding guidelines and provide training to team members

Required Qualifications

• CCS or CIC certification (required)
• Current or previous nursing/clinical experience or CDI certification (required)
• At least 5+ years of experience in Medicare or Medicare Advantage payment integrity or claims operations
• Previous experience in the insurance industry
• Deep understanding of CMS rules and regulations