Coding Compliance and Denials Manager - FT - Days

Who We Are

At Vitruvian Health, we serve with compassion. As the leading healthcare system for northwest Georgia and southeast Tennessee, we are committed not only to strengthening the health of our communities, but also to supporting the growth, success, and well‑being of every team member.

Our Legacy

Formerly Hamilton Health Care System, Vitruvian Health is built on a legacy of trust, innovation, and exceptional care. With more than 80 access points across the region—including Hamilton Medical Center and Bradley Medical Center—you’ll have the opportunity to be part of something bigger: a connected, mission‑driven team making a difference every day.

Our Values

Our core values—Professionalism, Respect, Integrity, Diversity, and Excellence (PRIDE)—guide every interaction and decision. We believe in empowering our people, celebrating what makes us unique, and delivering care that reflects the heart of our mission.

Your Career With Us

Join us and build a meaningful career where you’re valued, inspired, and supported to make a real impact.

Excellence. Every person. Every time.

JOB SUMMARY

The HIM Manager of Coding Compliance and Denials Management performs advanced level work related to clinical and DRG denial management. The individual is responsible for managing denials related to referral, authorizations, notifications, non-coverage, medical necessity, DRGs and others as assigned. The HIM Manager of Coding Compliance and Denials Management conducts comprehensive reviews of the medical necessity denial, and DRG Denial, reviews the medical record to make determinations if a revised claim needs to be submitted, if a retro authorization needs to be obtained, if a written appeal is needed, or if no action is needed.  The HIM Manager of Coding Compliance and Denials Management writes and submits professionally written appeals which include compelling arguments based on clinical documentation, third-party payer medical policies, and contract language. Appeals are submitted timely and tracked through final outcome. The manager will also handle audit-related / compliance responsibilities and other administrative duties as required.

This manager will actively manage, maintain, and communicate denial / appeal activity to appropriate stakeholders and report suspected or emerging trends related to payer denials to Revenue Cycle management. Additionally, the HIM Manager of Coding Compliance and Denials Management anticipates and responds to a wide variety of issues/concerns. The manager works independently to plan, schedule, and organize activities that directly impact hospital and physician reimbursement and assists in creating and maintaining documentation of key processes. This role is key to securing reimbursement and minimizing organizational write offs.

Assists the HIM Director with the planning, organizing, directing and coordination of the functions of the Health Information Management Coding Compliance area for Coding and CDI.  Performs project management activities including the development of action plans, design specifics, budget requirements and project management for all HIM systems.  Provides application support for the information systems utilized by the Health Information Management department.  Performs maintenance and updates to supported application software. Initiates and coordinates system documentation and quality initiatives.  Provides periodic status updates to HIM Director as required.  Reviews assigned work queue(s) daily and ensure timely processing of assignments in each queue.  Assists with internal and external coding audits. 

Codes, analyzes, and abstracts all medical records according to established classification system and enters the abstracted information into the hospital financial system. Identifies documents of poor quality.  Ensures all scanned documents are positioned correctly.  Identifies those that are incorrect.  Ensures each document is indexed to the correct patient/encounter.  Refers identified issues to appropriate scanning/QC staff for correction. Participates in department on-call by taking call during the specified weeks assigned and helping when needed at other times.

JOB QUALIFICATIONS

Education: Graduate of approved RHIA or RHIT program.

Licensure: Current RHIA, RHIT, or RN.

Experience: Three (3) years of experience in a healthcare revenue cycle or clinic operations role with one (1) of those years being in a role which included denial appeal writing.

Skills:             

• Experience with medical and insurance terminology, CPT and ICD coding structures, and billing forms (UB, 1500).
• Epic experience preferred.
• Focus on continuous process improvement
• Ability to make good judgments in demanding situations
• Ability to react to frequent changes in duties and volume of work
• A highly motivated, detail and service-oriented individual that can accurately set priorities, work effectively with minimal direction in a job environment involving creative leadership, possessing verbal communication skills, organizational and technical skills.
• Effective communication skills with multiple levels in the organization (e.g, managers, physicians, clinical and support staff)  
• Extensive writing capabilities / efficiencies  
• Ability to listen empathetically 
• Ability to write professional appeal letters
• Ability to organize details logically and accurately
• Ability to communicate with multiple levels in the organization (e.g, managers, physicians, clinical and support staff)
• Ability to maintain a strong relationship with various clinical and non-clinical team members to positively affect financial outcomes
• Ability to manage multiple tasks with ease and efficiency
• Self-starter with a willingness to try new ideas
• Ability to work independently and be result oriented
• Positive, can-do attitude coupled with a sense of urgency
• Effective interpersonal skills, including the ability to promote teamwork
• Strong problem-solving skills
• Ability to ensure a high level of customer satisfaction including employees, patients, visitors, faculty, referring physicians and external stakeholders
• Ability to use various computer applications with excellent PC operating skills (keyboard, mouse) and use of MS Office
• Broad knowledge of health care business office practices and principles
• Basic math skills and knowledge of general accounting principles
• Maintain confidentiality of sensitive information
• Knowledge of medical terminology, anatomy and physiology, DRG and APC assignment, and ICD-10-CM/PCS, CPT, and E/M coding systems
• Knowledge of Medicare, Medicaid and third-party reimbursement methodologies
• Knowledge of local, state and federal healthcare regulations
• Establish and update priorities and exercise accurate judgment during high stress and peak workload periods

PHYSICAL, MENTAL, ENVIRONMENTAL AND WORKING CONDITIONS

Works in a typical office setting. Moderate amount of walking which includes stairs with some stooping and bending.  Requires alternating on-call coverage. Medicalterminology and DRG Format, proven management skills, computer experience.

Full-Time Benefits

• 403(b) Matching (Retirement)
• Dental insurance
• Employee assistance program (EAP)
• Employee wellness program
• Employer paid Life and AD&D insurance
• Employer paid Short and Long-Term Disability
• Flexible Spending Accounts
• ICHRA for health insurance
• Paid Annual Leave (Time off)
• Vision insurance