Revenue Cycle Manager, Coding & Complex Denials

Columbia University
United States, New York, New York
Feb 08, 2025
Job Type: Officer of Administration Regular/Temporary: Regular Hours Per Week: 35 Standard Work Schedule: M-F Building: Primarily remote, must be in a Columbia University-approved telework state. Salary Range: $95,000-$110,000 The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to departmental budgets, qualifications, experience, education, licenses, specialty, and training. The above hiring range represents the University's good faith and reasonable estimate of the range of possible compensation at the time of posting. Position Summary The Manager, Coding and Complex Denials is responsible for overseeing daily operations of the Coding and Complex Denials unit, ensuring the accurate and timely resolution of coding-related denials, appeals, and escalations. Reporting to the Assistant Director, this role manages Supervisors and their teams, driving performance, compliance, and operational excellence. The Manager plays a key role in developing strategies to reduce denials, improve coding accuracy, and optimize revenue capture. This position ensures alignment with institutional policies, payer regulations, and industry standards while fostering collaboration across the Clinical Revenue Office (CRO). Responsibilities Operations: Oversee the day-to-day activities of Coding Supervisors and their teams, ensuring productivity and compliance with payer and institutional policies. Manage workflows for coding denial resolution, appeals submissions, and escalations, prioritizing high-dollar and complex cases. Ensure accurate and timely resolution of coding-related denials by monitoring work queues, addressing bottlenecks, and reallocating resources as needed. Develop, implement, and maintain standard operating procedures (SOPs) for coding denial workflows to enhance efficiency and accuracy. Collaborate with the Assistant Director to set operational priorities and align unit goals with broader organizational objectives. Denial Resolution and Escalations: Support Supervisors in addressing complex coding denial cases, providing guidance on appeals and appropriate resolution strategies. Monitor denial trends and root causes, implementing targeted interventions to address systemic issues. Partner with payers to resolve escalated cases, negotiate resolutions, and improve reimbursement outcomes. Lead efforts to optimize workflows for RAC audits and other payer-initiated reviews, ensuring compliance and timely responses. Compliance and Quality Assurance: Ensure all coding and denial management activities adhere to HIPAA, CMS, and institutional policies. Conduct regular audits of denial resolution processes to identify discrepancies, ensure accuracy, and maintain compliance. Stay updated on changes in coding standards (CPT, ICD-10, HCPCS), payer guidelines, and regulatory requirements, ensuring the unit remains current. Provide ongoing education to staff on compliance updates and industry best practices. People Management: Manage Coding Supervisors, conducting regular performance evaluations and providing feedback to support professional growth and development. Oversee team performance, ensuring productivity and quality benchmarks are consistently achieved. Facilitate training programs for staff, focusing on coding accuracy, denial management, and compliance. Lead regular team meetings to discuss updates, address challenges, and reinforce best practices. Collaborate with HR on recruiting, onboarding, and retaining high-performing team members. Data Analysis and Reporting: Monitor key performance indicators (KPIs) for coding accuracy, denial resolution rates, and team productivity. Analyze data to identify trends and areas for improvement, providing actionable insights to the Assistant Director. Prepare and present reports on unit performance, highlighting achievements, challenges, and strategic recommendations. Strategic Initiatives: Partner with the Assistant Director to develop and implement initiatives to reduce denials and optimize revenue capture. Contribute to organizational goals by identifying opportunities for process improvement and innovation within the coding unit. Collaborate with other CRO units to ensure seamless integration of coding and denial workflows across the revenue cycle. Please note: While this position is primarily remote, candidates must be in a Columbia University-approved telework state. There may be occasional requirements to visit the office for meetings or other business needs. Travel and accommodation costs associated with these visits will be the employee's responsibility and will not be reimbursed by the company. Minimum Qualifications Bachelor's degree in Health Information Management, Business Administration, or a related field, or equivalent combination of education and experience. Certified Professional Coder (CPC) required; additional certifications such as Certified Coding Specialist (CCS) or Certified Coding Specialist-Physician-based (CCS-P) preferred. A minimum of 4 years of experience in medical coding or revenue cycle management, including 2 years in a supervisory or managerial role. An equivalent combination of education, training, and experience may be considered. Advanced knowledge of CPT, ICD-10, and HCPCS coding standards and payer-specific guidelines, including Medicare and Medicaid. Proven leadership skills with a track record of managing and developing high-performing teams. Strong analytical and organizational skills, with the ability to monitor workflows, identify trends, and implement improvements. Excellent verbal and written communication skills, with the ability to interact effectively with staff, clinicians, and administrative stakeholders. Must successfully pass systems training requirements Preferred Qualifications At least 2 years of direct supervisory experience is preferred. Experience in an academic healthcare or central billing office setting. Familiarity with data analysis tools and experience generating reports for executive leadership. Competency Profile Patient Facing Competencies Minimum Proficiency Level Accountability & Self-Management Level 3 - Intermediate Adaptability to Change & Learning Agility Level 3 - Intermediate Communication Level 3 - Intermediate Customer Service & Patient Centered Level 3 - Intermediate Emotional Intelligence Level 3 - Intermediate Problem Solving & Decision Making Level 3 - Intermediate Productivity & Time Management Level 3 - Intermediate Teamwork & Collaboration Level 3 - Intermediate Quality, Patient & Workplace Safety Level 3 - Intermediate Leadership Competencies Minimum Proficiency Level Business Acumen & Vision Driver Level 3 - Intermediate Performance Management Level 4 - Advanced Innovation & Organizational Development Level 3 - Intermediate Equal Opportunity Employer / Disability / Veteran Columbia University is committed to the hiring of qualified local residents.