Job Information
CODAMETRIX Coding Quality Program Manager (E&M) in Boston, Massachusetts
CodaMetrix is revolutionizing Revenue Cycle Management with its AI-powered autonomous coding solution, a multi-specialty AI-platform that translates clinical information into accurate sets of medical codes. CodaMetrix’s autonomous coding drives efficiency under fee-for-service and value-based care models and supports improved patient care. We are passionate about getting physicians and healthcare providers away from the keyboard and back to clinical care.
Overview
Reporting to the Sr. Manager, Medical Coding & Audit, the Coding Quality Program Manager, will be a key member of the Medical Coding & Audit team. The Medical Coding & Audit team is responsible for model quality, outsourced vendor auditing, quality of production coding to support the CMX Quality Matrix and communicating coding quality topics to CMX customers.
The Coding Quality Program Manager is responsible for ensuring that CodaMetrix meets—and exceeds—our customers’ coding quality expectations. They will leverage their strong background in Evaluation and Management (E&M) medical coding (with a focus on Emergency Department (ED) coding), billing, and auditing to review, analyze, and enhance coding processes, both internally and externally. They will play a pivotal role in improving the quality and efficiency of coding operations by collaborating closely with cross-functional teams, including Machine Learning, Product, and Customer Implementations.
This role requires a proven ability to communicate complex coding issues and solutions to a wide range of stakeholders, alongside an unwavering commitment to continuous learning, quality, and innovation in medical coding practices.
Responsibilities
Customer & Workflow Analysis
Analyze and document customers’ coding practices and workflows to facilitate optimal use of the CodaMetrix product.
Identify and share best practices for coding automation and workflow improvements.
Surface customer coding and Billing business processes that do not meet established best practices or conflict with the CMX product offering
Coding Quality Management
Manage Coding Quality Assessment (CQA) projects, including work assignments, training, and quality assurance for offshore coding staff.
Leverage CodaMetrix coding standards when responding to client requests or internal inquiries and use them to anchor responses on coding related questions to drive world-class coding quality and consistency.
Present audit results to customer stakeholders and facilitate sign-off for go-live milestones.
Subject Matter Expertise
Serve as the internal and external Subject Matter Expert (SME) on medical coding and billing across assigned service lines, with a strong emphasis on E&M and ED coding.
Provide expert guidance on coding and billing questions to support Machine Learning and Product teams.
Collaboration & Knowledge Sharing
Develop and deliver evaluation and training materials on coding and billing to colleagues and customers to build internal competencies and champion continuous improvement initiatives.
Compliance & Professional Development
Proactively stay up to date with changes in medical coding and billing, as well as regulatory and payor policy changes to E/M coding, by maintaining relevant certifications and participating in ongoing education.
Uphold all legal and ethical requirements, ensuring accuracy, confidentiality, and compliance in all coding and audit activities.
Customer Implementations Support
Actively participate in customer implementations, providing coding expertise to ensure accurate and efficient deployment of CodaMetrix solutions.
Collaborate with cross-functional teams—such as Data Science, Product, and Customer Success—to address client needs and optimize results.
Vendor Project Management
Primary resource for validating partner audit results and assigning overall quality to the CMX E&M offering.
Oversight of outsource coding partners and their delivery of customer production coding results for E&M visits.
Requirements
Required
AHIMA or AAPC coding credential held for 5+ years.
5+ years of coding, auditing, or revenue cycle leadership experience with progressive growth in responsibilities, specifically in E&M services (including ED coding).
Excellent communication and customer service skills, capable of effectively engaging executives, directors, data scientists, and other stakeholders with varying levels of coding knowledge.
Strong organizational and detail-oriented approach with a demonstrated commitment to excellence and precision.
Critical thinking, intellectual curiosity, and creativity in problem-solving.
Ability to thrive under time constraints in a fast-paced environment.
Team-oriented approach with a positive and patient demeanor, fostering collaboration and continuous improvement.
The estimated hiring range for this role is $100,000 - $165,000 (plus applicable bonus/plus equity). This hiring range could vary by region based upon local market data. Final salary is ultimately decided upon taking into account a wide range of factors, including but not limited to: skills and experience, licensure and certifications, education, specific location and dynamic market data.
What CodaMetrix can offer you:
Learn more about our full-time employee benefits and how we take care of our team.
Health Insurance: We cover 80% of the cost of medical and dental insurance and offer vision insurance
Retirement: We offer a 401(k) plan that eligible employees can contribute to one month after their first day
Flexibility: We have a generous Paid Time Off policy, which is managed but not limited, so you can take the time you need to relax and rejuvenate
Learning: All new hires complete our 7-week Onboarding Program where they learn about our company and each of our departments through live sessions hosted by a variety of our leaders
Development: We provide annual performance evaluations and prioritize working with employees on what their individual growth looks like
Recognition: We recognize the outstanding achievements of our team through annual company awards where employees have the opportunity to nominate their peers
Office Location: A modern open plan workspace located in the bustling Back Bay neighborhood of Boston
Additional Employer Paid Benefits: We offer employer-paid life insurance and short-term and long-term disability insurance
Background Check Notice
All candidates will be required to complete a background check upon acceptance of a job offer.
Equal Employment Opportunity
Our company, as well as our products, are made better because we embrace diverse skills, perspectives, and ideas. CodaMetrix is an Equal Employment Opportunity Employer and all qualified applicants will receive consideration for employment.
Don’t meet every requirement? We invite you to apply anyway. Studies have shown that women, communities of color and historically underrepresented talent are less likely to apply to jobs unless they meet every single qualification. At CodaMetrix we are committed to building a diverse, inclusive and authentic workplace and encourage you to consider joining us.
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