CODING AND REVENUE INTEGRITY MANAGER

Coding And Revenue Integrity ManagerHorizon Health is a Critical Access, Rural Health Facility comprised of 25-inpatient beds located in Paris, IL & a multitude of outpatient clinic settings including Family Practice and Specialty Clinics in Paris and surrounding cities. We have been serving residents of Edgar County since 1968 though community education, emergency services, and outpatient care. As we continue to expand our services & locations, our community has grown far beyond Paris. Our rich history and strong community support pave the way for the future of healthcare as we serve you—our family, friends, and neighbors.The Manager of Coding & Revenue Integrity is responsible for the performance, accuracy, and compliance of hospital and professional coding, charge capture processes, and chargemaster (CDM) governance across the organization.This role provides operational leadership for hospital-based (HB) and professional-based (PB) coding functions, ensuring accurate code assignment, timely coding completion, and compliance with all regulatory and payer requirements. The Manager oversees revenue integrity activities, including charge capture processes and chargemaster (CDM) governance, supporting accurate reimbursement across all organizational service lines and reimbursement methodologies, including Critical Access Hospital (CAH), Rural Health Clinic (RHC), Emergency Medical Services (EMS), hospital-based (HB), professional-based (PB), and other provider-based services as applicable.Working in a Critical Access Hospital (CAH) environment, this role plays a critical part in optimizing reimbursement, reducing denials, and preventing revenue leakage. The Manager partners closely with clinical departments, Patient Access, and Revenue Cycle leadership to improve documentation, coding accuracy, and charge capture workflows, driving measurable improvements in financial performance and compliance.Essential Functions (Responsibilities/Accountabilities): Coding Operations (HB & PB) Oversee coding operations supporting multiple care settings and reimbursement methodologies, including CAH, RHC, EMS, hospital-based, professional-based, and other provider-based services as applicableMonitor coding productivity, accuracy, and turnaround times, implementing improvements as neededEnsure coding practices align with regulatory requirements, payer guidelines, and organizational policiesRevenue Integrity & Charge Capture Oversee charge capture processes across departments to ensure services provided are accurately documented and billedIdentify and resolve charge capture issues, including missing charges, incorrect coding, and workflow gapsCollaborate with clinical departments to improve documentation practices that support accurate coding, charge capture, and reimbursementChargemaster (CDM) Governance Maintain and oversee the hospital chargemaster, ensuring accuracy, completeness, and compliance with regulatory requirementsCoordinate implementation of annual regulatory coding updates, CPT/HCPCS changes, and reimbursement modifications impacting the chargemasterReview and update CDM entries, including CPT/HCPCS codes, revenue codes, and pricing alignmentPartner with Finance and Revenue Cycle leadership on CDM strategy and maintenance processesGovernment Reimbursement & Specialized Billing Support Support coding and revenue integrity processes across CAH, RHC, EMS, and other specialized reimbursement methodologiesMonitor regulatory and payer changes impacting coding and reimbursement and coordinate operational implementationPartner with Revenue Cycle leadership to address reimbursement risks associated with specialized billing programsDenials Prevention & Revenue Optimization Analyze coding and charge-related denials to identify root causes and implement corrective actionsPartner with Revenue Cycle teams to reduce denials and improve clean claim ratesSupport initiatives to improve reimbursement accuracy and reduce revenue leakageAuditing, Compliance & Education Conduct coding and charge capture audits to ensure compliance and identify improvement opportunitiesProvide education and training to coding staff, clinical departments, and other stakeholdersCoordinate internal and external coding audit activities and monitor corrective action plans to ensure sustained complianceEnsure audit readiness and compliance with all applicable regulatory requirementsData, Reporting & Performance Management Monitor and report key performance metrics, including coding accuracy, productivity, denial trends, and charge capture performanceUse data to identify trends, risks, and opportunities for improvementProvide regular reporting to Revenue Cycle leadershipStaff Leadership & Development Recruit, train, and develop coding and revenue integrity staffEstablish performance expectations and accountability measuresProvide coaching, feedback, and ongoing development to staffWorkflow Improvement & Standardization Evaluate and improve coding and charge capture workflows to enhance efficiency and accuracyDevelop and maintain standardized coding, documentation, charge capture, and revenue integrity policies and proceduresImplement best practices for coding, documentation, and revenue integrity processesCollaboration & Cross-Functional Alignment Partner with providers, clinical departments, Patient Access, Finance, and the Central Business Office to improve documentation quality, reduce reimbursement risk, and strengthen end-to-end revenue cycle performance.The responsibilities listed above are not all-inclusive; other activities may be required in support of the hospital's goals and objectives.Position Requirements: Education Associate's degree required, Bachelor's degree in Health Information Management, Healthcare Administration, or related field preferredRelevant coding certifications required (e.g., RHIT, RHIA, CCS, CPC)Experience 5+ years of experience in hospital and/or professional coding, revenue integrity, or charge capture2–3 years of leadership or supervisory experience requiredExperience in hospital-based (HB) and professional-based (PB) coding requiredExperience supporting diverse reimbursement methodologies, including Critical Access Hospital (CAH), Rural Health Clinic (RHC), Emergency Medical Services (EMS), and other provider-based services preferredDemonstrated experience improving coding accuracy, reducing denials, or enhancing charge capture processesRegulatory & Technical Knowledge Comprehensive knowledge of ICD-10-CM/PCS, CPT, and HCPCS coding guidelinesStrong understanding of Medicare, Medicaid, commercial payer requirements, and reimbursement methodologies impacting hospital, professional, CAH, RHC, EMS, and provider-based servicesFamiliarity with NCCI edits, medical necessity requirements, LCD/NCD guidance, and government reimbursement regulationsKnowledge of chargemaster (CDM) structure, maintenance, and pricing alignmentUnderstanding of revenue integrity principles, including charge capture, documentation alignment, and compliance requirementsFamiliarity with audit processes, coding compliance, and regulatory standards.Systems, Data & Analytics Experience working with EHR systems, coding tools, encoder software, and billing systemsAbility to analyze coding, denial, and charge capture data to identify trends and improvement opportunitiesProficiency in reporting tools and data analysis (Excel or equivalent)Leadership & Professional Competencies Strong operational leadership skills with the ability to manage coding workflows and revenue integrity processesDemonstrated ability to lead, develop, and mentor coding and revenue integrity staffExcellent communication skills, with the ability to collaborate with clinical, financial, and operational stakeholdersAbility to drive process improvement, standardization, and accountability across departments.High level of integrity, accuracy, and attention to detailPay Range: Pay ranges from $69,903k to $111,844k (rate of pay is based on applicable years of experience)Horizon Health is committed to caring not only for our patients, but for our staff as well. We offer you an extensive total compensation and benefits package. As an employee of Horizon Health, your benefits include