Billing & Coding Manager
Position Summary:
The Billing & Coding Manager oversees the practice’s billing, coding, claims, denials, and accounts receivable operations. This position is responsible for ensuring accurate coding, timely claim submission, appropriate reimbursement, compliance with payer requirements, and consistent follow-up on outstanding balances and denials.
Key Responsibilities:
- Manage and supervise billing and coding staff.
- Ensure accurate CPT, HCPCS, ICD-10-CM, and modifier usage.
- Review documentation to ensure services billed are supported by the medical record.
- Monitor claims from submission through payment or denial.
- Oversee denial management and identify recurring denial trends.
- Ensure all billers review the complete patient and guarantor account before making billing decisions.
- Monitor payer-specific requirements, including prior authorizations, medical necessity, referrals, and documentation requirements.
- Review EOBs/ERAs and ensure payments are posted accurately.
- Monitor accounts receivable, aging reports, underpayments, and unpaid claims.
- Work with clinical and front-office teams to correct documentation, registration, authorization, and coding issues.
- Coordinate with providers regarding documentation requirements that affect reimbursement.
- Perform routine coding and billing audits.
- Identify compliance risks and implement corrective action.
- Maintain billing workflows and written procedures.
- Train staff on coding updates, payer policies, denial prevention, and billing procedures.
- Monitor productivity and accuracy of billing staff.
- Work with clearinghouses and payer representatives to resolve claim issues.
- Prepare regular reports for practice leadership regarding collections, denials, A/R, and billing performance.
- Stay current with CMS, Medicare, Medicaid, commercial payer, CPT, ICD-10, and coding changes.
Important Compliance Responsibility
The Billing & Coding Manager should ensure that every billed service is supported by appropriate documentation. Office notes, procedure reports, infusion records, diagnoses, medical necessity, and other supporting documentation can directly affect whether a claim is paid.
Insurance companies and government payers may audit claims and recoup payments when documentation does not support the service billed, even if the claim was initially paid. The manager should therefore establish regular pre-bill and post-payment auditing processes to identify problems before they become larger financial or compliance issues.
Key Performance Metrics
- Clean claim rate
- Initial denial rate
- Denial overturn rate
- Days in A/R
- A/R over 90 days
- Net collection rate
- Payment variance/underpayments
- Unbilled claims
- Timely filing denials
- Authorization-related denials
- Coding-related denials
- Medical necessity denials
- Staff productivity and accuracy
Ideal Qualifications:
- 3–5+ years of medical billing/coding experience
- Management or supervisory experience
- Strong knowledge of CPT, ICD-10-CM, HCPCS, and modifiers
- Experience with Medicare, Medicaid, and commercial insurance
- Experience with EHR (EPIC) and clearinghouse systems
- Strong understanding of denial management and A/R
- Knowledge of medical documentation and compliance requirements
- Gastroenterology or multispecialty practice experience preferred
- CPC, CCS, CPB, or equivalent certification REQUIRED
