Client Management:
-Establish and maintain trusted client relationships as the primary point of contact for coding denials and hospital billing services.
-Understand client challenges related to coding compliance and billing workflows and recommend tailored solutions.
-Conduct regular meetings to review KPIs, denial trends, billing performance, and strategic opportunities.
Operational Leadership:
-Oversee daily operations of coding denial management and hospital billing workflows ensuring service levels and quality standards are met.
-Lead onshore and offshore teams managing coding denials appeals, payor interactions, documentation reviews, and billing accuracy.
-Ensure compliance with payer regulations and documentation standards to prevent denials and facilitate timely reimbursements.
Process Improvement & Strategic Planning:
-Identify gaps and implement strategies to reduce coding denials and improve hospital billing efficiency.
-Drive continuous improvement initiatives leveraging automation, enhanced workflows, and staff training.
-Partner with analytics and technology teams to develop reporting tools and system enhancements that support coding and billing accuracy.
Performance Monitoring and Reporting:
-Monitor key metrics such as denial rates, coding accuracy, claim resolution times, days in accounts receivable, and collections impact.
-Prepare and present comprehensive dashboards and reports to clients and internal leadership.
-Use data-driven insights to influence operational decisions and client advisory.
Compliance & Quality Assurance:
-Ensure all coding denial and hospital billing processes adhere to applicable regulations and payer guidelines.
-Develop and maintain quality assurance protocols, conducting audits and reviews to guarantee accuracy and compliance.
-Update teams continuously on changes in coding standards (ICD-10, CPT, HCPCS) and payer policies impacting denials.
Qualifications:
-Extensive knowledge of coding denial workflows, hospital billing processes, payer medical necessity guidelines, and coding compliance regulations for at least 10 years.
-Proven ability to lead teams focused on clinical and coding denials resolution and hospital billing activities.
-Strong expertise in payer policies for commercial, Medicare, and Medicaid, including appeals and reimbursement strategies.
-Skilled in analyzing revenue cycle data to identify denial trends, root causes, and opportunities for billing process improvement.
-Experience developing and implementing strategic initiatives that reduce denial volumes, improve cash flow, and enhance coding accuracy.
Senior Manager - Coding Denials, Hospital Billing • Quezon City, Philippines
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