Coding Manager Job Description

Hospitals and physician groups depend on precise ICD-10-CM, CPT, and HCPCS code assignment, since DRG and APC payment methodologies translate that data directly into reimbursement and compliance exposure under CMS rules. The Coding Manager exists to keep that translation accurate. Sitting between the coding staff and revenue cycle leadership, this role owns the accuracy of charge capture and oversees coder productivity and DRG reclassification review. It also answers for credentialing standards such as RHIA, RHIT, or CCS that keep the department audit-ready.

Success as a Coding Manager means keeping every ICD-10-CM, CPT, and HCPCS code assignment accurate enough to withstand a payer audit while the department still hits its productivity targets. The position typically reports to a Director of Revenue Cycle or HIM Director and oversees a team of coders and quality reviewers across inpatient and outpatient services.

Career Impact: Hands-on ownership of DRG and APC accuracy builds the audit track record that RHIA-, RHIT-, and CCS-credentialed coders use to move into revenue cycle leadership.

Business Impact: Every corrected code before submission keeps denials and unbilled accounts off the hospital's revenue cycle numbers.

Growth Opportunity: The role is a direct step toward a Director of Revenue Cycle or HIM Director seat for managers who master both compliance and staff productivity.

• Lead daily coding operations across inpatient, outpatient, and ancillary services to keep turnaround times within target.
• Audit coder accuracy on ICD-10-CM, CPT, and HCPCS assignments to catch DRG or APC errors before billing.
• Coordinate with medical staff and clinical documentation improvement teams to resolve ambiguous or incomplete documentation.
• Monitor productivity and quality metrics for the coding team and counsel underperformers toward the standard.
• Develop and update coding compliance policies to reflect current CMS, payer, and regulatory requirements.
• Mentor coders and quality specialists through ongoing education on coding system and payer guideline changes.
• Review denied claims tied to coding errors and coordinate corrections with revenue cycle and billing staff.
• Report coding trends and compliance risks to revenue cycle leadership on a regular cadence.

• Bachelor's degree in health information management, business administration, or a related field, or equivalent work experience.
• 3 or more years of coding management or supervisory experience, with a background in ICD-10-CM and CPT coding.
• Working knowledge of DRG and APC payment methodologies and how they apply across inpatient and outpatient services.
• Coding certification such as CCS, CPC, RHIA, or RHIT, or ability to obtain one soon after hire.
• Demonstrated experience monitoring coder productivity and quality metrics and addressing performance gaps directly.
• Strong written and verbal communication skills for working with medical staff, compliance, and revenue cycle teams.
• Ability to interpret coding guidelines and regulatory changes and translate them into daily team practice.
• Familiarity with HIPAA privacy requirements and the compliance standards of a hospital or health system.

• Experience overseeing risk adjustment or HCC coding programs within a health plan or payer organization setting.
• Prior experience managing contracted, remote, or offsite coding teams spanning multiple hospital or clinic sites.
• Additional specialty credentials such as CRC, CCS-P, or a coding credential beyond the base requirement.
• Background in denial management and reducing days not final billed within an acute care or physician practice setting.

• Coding accuracy rate, reflecting how closely code assignments match clinical documentation.
• Days not final billed, measuring how quickly coded charts move to billing.
• Denial rate tied to coding errors, showing how well queries and corrections are caught pre-bill.
• Coder productivity against target, tracking whether the team meets its daily or weekly volume goals.
• Compliance audit pass rate, showing how the department performs against CMS and payer review standards.

• Base Salary Range: $75,000 to $95,000 per year, varying by facility size and region
• Bonus: Annual performance bonus of 3 to 8 percent of base salary at many employers
• Equity: Not typically offered outside for-profit healthcare corporations
• Health Benefits: Medical, dental, and vision coverage, often with employer premium contributions
• PTO: 15 to 20 days of paid time off plus standard holidays
• Common Perks: Remote or hybrid work options, tuition assistance, and certification reimbursement

Figures are estimates based on general US market benchmarks and may be outdated. Adjust based on location, company size, and seniority level.

Employment is contingent on successful completion of a background check and, where applicable, drug screening consistent with hospital and health system policy. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability, or any other status protected under federal, state, and local law. Reasonable accommodation is available for qualified individuals with disabilities upon request. Candidates must be authorized to work in the United States.

The Coding Manager leads centralized charge control and clinical coding accuracy across inpatient and outpatient service lines, keeping HIPAA compliance and revenue integrity intact. Reporting to the Director of Revenue Cycle, the manager supervises the coding staff and partners with medical staff and finance leadership to reduce charge capture denials.

Key Responsibilities

• Manage the operation of clinical coding across all revenue-generating service lines, including inpatient and outpatient coding, clinical data abstraction, report writing, and HIPAA compliance.
• Maintain the confidentiality of all patient and staff records.
• Review billing requirements and develop and maintain policies and procedures that support clinical coding and compliance while mitigating compliance risks.
• Collaborate with medical staff and departments to ensure the quality and consistency of clinical documentation.
• Track risk exposure incidents and report the financial impact of compliance risks to the Director of Revenue Cycle.
• Coordinate audits of coding and documentation practices and lead continuous quality improvement activities for regulatory compliance.
• Prepare and conduct education and training programs to keep staff current on coding, reimbursement, and regulatory changes.
• Manage employees, including work schedules, performance appraisals, interviewing, and providing instruction to staff.
• Ensure proper charge capture practices are implemented consistently across the organization.
• Develop and implement operational processes for timely and accurate charge entry that reduce charge capture-related denials.
• Conduct quality and productivity reviews at least quarterly and monthly to ensure accurate charging practices.
• Collaborate with clinical leadership to resolve issues with coding, charge capture, compliance, and data across revenue cycle areas.
• Serve as a resource on information security, record retention, and classification systems for health record documentation.
• Monitor key financial and operational indicators related to coding and stay current on CMS and payer guideline changes.

Required Qualifications

• Associate's degree in business administration, health information, or a related field, or an equivalent combination of education and experience.
• Bachelor's degree in business administration, health information, or a related field.
• License or certification in RHIA, RHIT, CCS, CCS-P, or CPC/COC coding required.
• CEMC or CPMA certification required, or obtained within one year of hire.
• RHIA, RHIT, or other auditing credentials preferred.
• 3 or more years of professional coding supervisory experience, including working knowledge of medical terminology and correct coding principles of CPT, HCPCS, and ICD-10, NCCI edits, and payer policies.
• 3 or more years of management experience in a multi-facility, integrated health care delivery system.
• 5 or more years of clinical or acute coding experience.
• Strong experience in acute care or professional fee coding, charge capture, error and denial management, process improvement, and other functions related to revenue and reimbursement integrity.
• Knowledge of and experience with revenue integrity and charge capture in an acute care or physician practice setting.
• Strong knowledge of CPT, UB Revenue Codes, ICD-10-CM codes, and related regulatory and compliance guidelines.
• Strong analytical and statistical skills.
• Excellent written and verbal communication skills, change management skills, and the ability to effectively manage multiple priorities simultaneously.
• Ability to understand and interpret complex issues and clinical processes and recommend improvements.

Embedded within the health information management department, the Coding Manager oversees daily coding operations for inpatient and outpatient medical records, building a formal audit process that keeps ICD-10 and CPT assignments accurate for government and commercial payers. Working closely with the Compliance Officer and healthcare providers, the manager analyzes coding trends and delivers targeted education that keeps documentation and billing aligned across the organization.

Core Functions

• Supervise and perform a wide range of activities about the review, coding and billing of inpatient and outpatient medical record information for healthcare providers and patients.
• Establish, implement, and maintain a formalized review process for coding compliance, including a formal audit process, and design and use audit tools to monitor coding and billing accuracy.
• Oversee data quality reviews on inpatient records to validate ICD-10-CM and other codes, check for missed secondary diagnoses and procedures, and ensure compliance with reporting requirements.
• Cooperate with the Compliance Officer to review current Office of Inspector General work plans for potential risk areas.
• Perform data quality reviews on inpatient and outpatient encounters to validate ICD-10-CM, CPT, and HCPCS Level II code and modifier assignments and verify APC group appropriateness.
• Perform follow-through reviews to confirm that billing accurately reflects coding documentation.
• Create and monitor reports on code utilization to identify patterns, trends, and variations in assigned levels of service.
• Oversee continuous evaluation of clinical documentation quality to identify incomplete documentation affecting code selection and resulting groups and payment.
• Provide training for healthcare professionals on technical coding guidelines, documentation techniques, medical terminology, and disease processes.
• Maintain knowledge of current coding certifications and perform complex coding and abstraction work as needed.
• Select, assign, and train coding and clerical staff, direct and evaluate their work, and manage leave requests and disciplinary action.
• Monitor unbilled account reports and hold lists to reduce accounts receivable days for claims awaiting coder review.
• Represent the department at coding workshops, stay current on HIPAA and transaction code set requirements, and share regulatory updates with staff.

Qualifications & Experience

• Bachelor's degree, preferred but not required.
• Current AAPC Certified Professional Coder certification required.
• 4 or more years of related physician coding and billing experience or training, or an equivalent combination of education and experience.
• Strong computer skills and knowledge of EMR systems, with Athena knowledge preferred but not required.
• Flexibility in work hours and the ability to multitask effectively.
• Ability to perform venipuncture as required.
• Ability to occasionally stand, walk, stoop, kneel, crouch, or crawl while performing job duties.

Reporting to leadership on the coding quality assurance program, the Coding Manager builds the yearly QA and education plan that keeps HCC and risk adjustment coding compliant with CMS and third-party requirements. Partnering with coding vendors and quality assurance specialists, the manager delivers recommendations that mitigate risk and protect revenue opportunities across the organization.

Primary Duties

• Lead and direct the quality assurance program, establishing, measuring, and documenting KPIs and mitigation plans to monitor and control coding integrity.
• Provide expertise on coding compliance for new and existing services, ensuring compliance with organizational, federal, state, and third-party requirements.
• Collaborate on and recommend solutions that mitigate risk and optimize revenue opportunities.
• Develop methods to communicate information through presentations, reports, educational programs, and memoranda for QA specialists, coding vendors, and staff.
• Contribute to department goals for meeting key productivity metrics.
• Address internal and external customer issues and requests promptly to maintain coding compliance and accuracy.
• Assist in training and cross-training of staff.
• Perform and analyze periodic reporting.
• Provide mentoring, coaching, and performance reviews for direct reports.

Skills & Qualifications

• CPC or CCS certification required.
• RHIA or RHIT strongly preferred.
• 5 or more years of CMS and HHS HCC or risk adjustment coding experience, with CRC preferred.
• 5 or more years of leadership experience managing complex and diverse operational teams.
• Experience overseeing remote, work-at-home operations.
• Strong managerial, financial, and analytical skills.
• Proficient with G Suite.
• Consistent commitment to quality, customer focus, productivity, and process improvement.
• Strong communication skills to interact effectively with all levels of the organization, business unit leaders, and staff tactfully and positively.
• Exceptional interpersonal skills and proven success in complex and ambiguous environments.
• Ability to work independently, with high productivity, and to regularly meet deadlines.

Sitting at the intersection of clinical documentation and regulatory reporting, the Coding Manager leads daily coding operations for inpatient, outpatient, emergency, and ancillary services while keeping DRG and APC data accurate for CMS and other agencies. Operating across medical staff, revenue integrity, and finance teams, the manager resolves coding and charge capture issues and manages a coding section held to strict turnaround and compliance standards.

Duties

• Ensure coding processes and guidelines meet state, federal, and hospital requirements and standards.
• Work closely with medical staff to improve clinical documentation and facilitate accurate coding.
• Collaborate with revenue integrity program managers.
• Reinforce the need for coders to send compliant physician queries as appropriate.
• Manage external clinical data and statistical reporting to regulatory and industry agencies, monitoring accuracy and facilitating error corrections.
• Manage internal clinical data and statistical reports for clinicians, researchers, and financial and business planning.
• Manage daily operations and activities in the coding section to ensure accurate and timely coding of inpatient, outpatient, emergency, and ancillary services.
• Monitor the information system infrastructure supporting coding and data reporting, including encoder software and billing applications.
• Provide leadership and expertise in ICD-10-CM, ICD-10-PCS, and CPT coding systems.
• Provide leadership and expertise in DRG and APC payment methodology as appropriate.
• Manage staff productivity and quality goals and address performance through corrective action or improvement plans.
• Manage work queues effectively, meeting turnaround time goals, cross-training staff, and providing timely provider feedback.
• Assist in writing and maintaining policies, procedures, and training materials for the section.
• Direct training of new employees, conduct performance appraisals, and take appropriate personnel actions as necessary.

Requirements

• Bachelor's degree in a work-related field or discipline from an accredited college or university, or relevant experience instead of a degree.
• RHIA, RHIT, or CCS certification.
• 5 or more years of progressively responsible and directly related work experience.
• Knowledge of health information from discharge, coding, billing, and data reporting.
• Knowledge of ICD-9/ICD-10 and CPT-4 coding, APR and MS-DRG and APC assignment, and CMS compliance issues.
• Knowledge of local, state, and federal regulatory requirements related to the functional area.
• Knowledge of principles and practices of organization, administration, and personnel management.
• Knowledge of coding software, including groupers, compliance tools, editors, optimizers, and encoders.
• Ability to communicate complex concepts in simple form to cross-functional departments or teams.
• Ability to effectively collaborate with medical staff and other hospital departments.
• Ability to manage complex projects and resources, including people, costs, and time.
• Ability to mediate and resolve complex problems and issues.
• Ability to solve problems and identify solutions.
• Ability to strategize, plan, and implement change.

A key member of the health information management department, the Coding Manager owns inpatient, observation, day surgery, emergency, and outpatient coding programs and keeps them aligned with CMS, AMA, and AHIMA standards. Collaborating across clinical documentation, physician, and facility leadership, the manager monitors coder accuracy and productivity and keeps the department audit ready.

Functions

• Plan, organize, and supervise inpatient, observation, day surgery, emergency department, and outpatient coding programs.
• Oversee post-discharge physician query processes.
• Manage encoder software processes and the coding compliance plan.
• Disseminate coding changes and updates to staff.
• Identify coder educational needs through continual monitoring and auditing of coder accuracy.
• Monitor charts not yet finally coded and establish targets by patient type and coder.
• Monitor and report individual coder productivity and coach and counsel underperformers.
• Assign and reassign uncoded charts to coders as needed to manage the coding backlog.
• Evaluate individual coder accuracy through focused audits and identify education needs to improve accuracy.
• Review DRG reclassifications before and after assigning corrections, and track and trend patterns by payer, coder, DRG, and physician.
• Monitor the coding compliance manual and industry publications and implement changes as necessary.
• Provide input on coding section needs for the annual budget and monitor expenditures for budget compliance.
• Attend meetings within and outside the facility to provide input and act as a coding information resource.
• Provide input on departmental budget specific to the area of responsibility.

Experience & Qualifications

• Associate degree in health science administration or HIM technology, minimum, required.
• Bachelor's degree, preferred.
• RHIT, CCS, CCA, or CPC-H certification required.
• RHIA certification required.
• 3 or more years of supervision of coding staff, required.
• 5 or more years of progressive management experience.
• Extensive knowledge of medical record documentation requirements mandated by medical staff bylaws, rules, and regulations.
• Knowledge of state and federal regulations regarding patient confidentiality.
• Thorough and detailed knowledge of ICD-10-CM, ICD-10-PCS, and CPT coding systems.
• Skilled in formulating and writing statistical reports.
• Skilled in performing quality assessment and analysis.
• Computer training in HBOC Star, 3M Coding and Reimbursement software, SoftMed Systems, MS Office, Horizon Patient Folder, Groupwise, and dictation and transcription systems.
• Excellent verbal and written communication and interpersonal skills.
• Strong interpersonal skills and the ability to work collaboratively with clinical documentation integrity, quality, and other facility leaders.

Timely, accurate claims across a network of medical centers depend on the Coding Manager, who owns coder training, site audits, and coding risk resolution for each facility. Serving as the liaison between facility HIM staff and corporate leadership, the manager reviews new coder work on a pre-bill basis and keeps every site current on coding regulations.

Accountabilities

• Manage coders at each medical center, including communicating and resolving issues identified by HIM staff, addressing client-identified issues within 24 hours, excluding weekends.
• Participate in calls with new customers to identify needs and request applicable facility policies and procedures.
• Train and orient new coders on site specifics and access to client information systems.
• Perform preliminary and routine audits on coding staff at each managed site, auditing all new coders' work on a pre-bill basis.
• Develop site-specific procedures for each medical center based on received policies and procedures and other communicated information.
• Communicate requests for new projects received from medical centers to leadership before starting work.
• Respond to coding staff questions with applicable references as appropriate.
• Identify coding risks or client issues proactively and recommend solutions to leadership.
• Review and interview qualified candidates for coding roles per the standard process.
• Complete weekly activity status reports and participate in weekly remote coding update conference calls.
• Communicate professionally and effectively with clients, coding staff, and corporate staff.
• Keep current with new laws, regulations, and guidelines related to coding.

Technical Qualifications

• Formal HIM education with national certification such as RHIA, RHIT, CCS, or CPC required.
• 5 or more years of inpatient and outpatient hospital experience or professional fee experience.
• 3 or more years of inpatient and outpatient hospital auditing experience, which may run concurrently with coding experience.
• Previous management experience.
• Auditing experience or a strong training background in coding and reimbursement, preferred.
• Good oral and written communication skills.

As the Coding Manager, this role owns coding team performance and audit documentation that keeps HCC risk adjustment data accurate for CMS submission. The risk adjustment program relies on this work to pass CMS data validation and to keep contracted coding vendors compliant with governing requirements.

Activities

• Monitor coding and abstracting productivity and quality to ensure improvement standards are maintained and achieved.
• Partner with local markets and enterprise risk adjustment leadership to support performance guidelines for quality and productivity.
• Manage and maintain a comprehensive tracking and management tool for coding workload and prioritization.
• Manage coding activities for all assigned coders and ensure tasks are completed in a timely manner.
• Ensure compliance with applicable federal, state, and local regulations and organizational standards and policies.
• Assist with CMS data validation activities, including suggested record selections, tracking, and submission.
• Keep updated on new statutes, regulations, and policies and distribute updates as required.
• Provide guidance in coding and abstraction production, quality assurance, auditing, and training activities.
• Support or perform chart reviews and HCC coding to ensure timely reviews.
• Collaborate on and sustain provider feedback and educational materials.
• Provide regular reporting of key metrics.

Position Requirements

• Bachelor's degree in business administration, healthcare management, or a related field, or equivalent experience, desired.
• Coding certification such as CCS, CCS-P, or CCA through AHIMA, or CPC, COC, or CIC through AAPC, required.
• Additional CRC certification required.
• Additional RHIA or RHIT preferred.
• 6 or more years of coding experience, including prior managerial experience.
• 3 or more years of professional coding experience in a medical group, IPA, MSO, or health plan setting, required.
• Proficient user of Microsoft Suite.
• Ability to work independently and manage competing priorities.
• Excellent verbal, written, and interpersonal communication skills.
• Dependable and highly motivated team player.
• Strong organizational skills and attention to detail.

Coding Manager leads first-line supervision of up to 25 internal and agency coders, keeping coding quality and staffing schedules aligned with revenue cycle and HIM department needs. Success in the position means catching performance issues early, keeping every work queue covered, and turning coder and documentation data into clear reports for leadership.

Operational Focus

• Provide daily supervision of coding staff and provide feedback to the coding manager on exceptional and substandard performance.
• Participate in process improvement projects and support work needed to meet department and institutional goals.
• Ensure all coding team members follow official policies and standard procedures and address violations through appropriate discipline.
• Counsel coding staff on actions required to meet minimum performance requirements.
• Provide or arrange necessary knowledge-based resources required by coding staff to meet quality and production standards.
• Prepare staffing schedules to provide adequate coverage for all work queues and bodies of work.
• Compile, analyze, and present data related to coder performance, documentation issues, and charging errors.

Knowledge, Skills & Abilities

• 5 or more years of coding supervisory or managerial experience.
• Certification as a Certified Professional Coder (CPC) or Certified Outpatient Coder (COC).
• Experience as a professional coder skilled in primary care and multiple specialties, including surgeries.
• In-depth knowledge of coding processes, coding systems software, workflow management, and electronic medical records.
• Advanced knowledge of ICD-10 CM/PCS and CPT/HCPCS coding systems and conventions.
• Experience with Epic, 3M, and Excel.
• Ability to maintain supervisor work queues, assist as necessary to manage backlog, and provide education and training to coders.
• Strong organizational, planning, scheduling, and project management abilities.
• Excellent oral and written communication skills.
• Ability to ensure a high level of customer satisfaction among employees, patients, visitors, and other departments.
• Ability to problem-solve and multitask in a challenging, busy environment.
• Proficient in providing customer service to departments, providers, and leadership.

The Coding Manager oversees coding and clinical documentation improvement staff, controlling audit activity and training so ICD-10 code assignments stay accurate across the organization. Reporting to hospital leadership, the manager partners with regulatory agencies and department budget owners to keep compliance standards, staffing, and expenditures on track.

Key Deliverables

• Supervise employees, provide direction, coach, train, and develop staff.
• Manage performance to organizational goals and expectations.
• Prepare, manage, and adhere to the department budget to maintain expenditure controls.
• Control, monitor, audit, and train the coding and clinical documentation improvement (CDI) staff.
• Oversee CDI activities, including concurrent review and queries and provider education.
• Ensure compliance with hospital policies and procedures and outside regulatory agency requirements.

Professional Experience

• Bachelor's degree in information services, business administration, healthcare management, or a related field, required, with a master's degree preferred.
• RHIT or RHIA certification required, with Certified ICD-10 Trainer preferred.
• Experience in health information management, required.
• Experience with ICD-10 coding, required.
• Experience in clinical documentation improvement, preferred.
• 5 to 7 years of relevant experience, preferred.
• 3 to 5 years of experience supervising staff, preferred.