Clinical Coding Manager

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