Operations Manager - Quality (Medical Coding)

Operations Manager - Quality (Medical Coding)

The Operations Manager – Quality Medical Coding is responsible for leading coding quality initiatives, driving compliance, and ensuring the accuracy and integrity of medical coding operations across multiple specialties and service lines. This role oversees coding quality programs, audit processes, education initiatives, and performance improvement strategies to ensure adherence to client requirements, regulatory guidelines, and industry standards.

The Operations Manager partners with coding leaders, clients, and cross-functional teams to optimize coding accuracy, enhance operational efficiency, reduce compliance risk, and support organizational goals.

Key Responsibilities

• Lead and manage coding quality assurance teams across inpatient, outpatient, professional fee, and specialty coding functions.
• Develop and implement quality management strategies, audit methodologies, and performance improvement initiatives.
• Oversee routine and focused coding audits to ensure compliance with applicable coding guidelines and payer regulations.
• Monitor coding accuracy, productivity, and quality metrics, identifying trends and opportunities for improvement.
• Analyze audit findings and create action plans to address coding variances and knowledge gaps.
• Ensure compliance with regulatory requirements and coding standards, including ICD-10-CM, ICD-10-PCS, CPT, HCPCS Level II, and official coding guidelines.
• Collaborate with operations leaders, educators, and clients to drive continuous process improvements.
• Establish and maintain coding quality scorecards, dashboards, and key performance indicators (KPIs).
• Lead root cause analyses for coding errors, denials, and audit discrepancies.
• Oversee coder education programs, remediation plans, and competency assessments.
• Support internal and external audits, including client audits and regulatory reviews.
• Ensure adherence to organizational policies, compliance standards, data privacy regulations, and information security requirements.
• Provide strategic recommendations to improve coding quality, optimize reimbursement, and mitigate compliance risks.
• Manage team performance through coaching, mentoring, succession planning, and performance evaluations.
• Facilitate regular calibration sessions to ensure audit consistency and inter-rater reliability.
• Prepare and present operational reviews, quality reports, and executive summaries to senior leadership and clients.

Qualifications

Bachelor's degree in Nursing, or any medical allied course

Active coding certification required, such as

CPC

CCS

CCS-P

CIC

RHIA

RHIT

• Additional quality or auditing certifications are an advantage.
• Minimum of 7–10 years of progressive experience in medical coding, coding quality, auditing, or revenue cycle management.
• Minimum of 3–5 years of leadership experience managing coding quality teams in a healthcare or outsourcing environment.
• Extensive knowledge of inpatient, outpatient, and professional fee coding methodologies.
• Strong understanding of reimbursement systems, including MS-DRG, APR-DRG, APC, and risk adjustment models.
• Experience with electronic health records (EHR), encoder software, computer-assisted coding (CAC), and audit platforms.
• Demonstrated experience managing client relationships and leading quality improvement initiatives.

Knowledge, Skills, and Abilities

• Strong expertise in medical coding regulations, payer requirements, and compliance standards.
• Advanced analytical and problem-solving skills with the ability to interpret complex data.
• Proven ability to lead large teams and manage multiple priorities in a fast-paced environment.
• Excellent communication, presentation, and stakeholder management skills.
• Strong project management and process improvement capabilities.
• Proficiency in Microsoft Office applications, including Excel, PowerPoint, and reporting tools.
• Experience with Lean, Six Sigma, or other continuous improvement methodologies is preferred.
• Ability to influence cross-functional teams and drive organizational change.
• High attention to detail with a focus on quality and accuracy.