Director Coding Operations Revenue Cycle (East Coast resident EST)

Job Summary This position oversees and directs the team responsible for ensuring correct coding across the system. It is primarily responsible for coding quality improvement and staff education, ensuring the accuracy of coding assignments using random auditing methodology, responding to requests from the Central Business Office regarding medical record investigation for outpatient/inpatient billing due to claims holding for the National Correct Coding Initiative (NCCI), Outpatient Code Editor (OCE), or any other payor edits, and communicating coding processes and program status regularly through mass communications to physicians, clinical operations staff, and leadership. Job Duties Provides direction and management to the Professional Coding Operations Department. Maintains integrity, quality, accuracy and performance of the coding program. Responds to requests from billing office for claims holding in the billing system as a result of payor edits or rejections. Reviews account detail and compares to the medical records for accurate selection of diagnoses and procedure codes as a quality measure for all coding activity. Reviews Local Medical Review Policies and other third‑party payor documents to ensure codes meet payor billing requirements. Provides consultative support to clinical areas on a daily basis for correct code reporting related to revenue enhancement. Accesses patient charge detail on the financial system to reconcile documentation from the medical record to the final bill, ensuring compliance. Acts as a liaison with physicians to resolve discrepancies regarding diagnoses and procedures based on standard clinical pathways and translation of clinical data into coded form. Provides suggestions and supporting information to reduce diagnoses and procedure edits. Researches coding compliance, keeps up‑to‑date with focus areas of the OIG, HCFA, PRS and other payors, and develops training materials for coding staff and physicians. Conducts and documents training sessions related to coding updates. Directs revenue‑cycle activities to ensure cost effectiveness and organizational efficiency. Provides direction to functions that inter‑relate with other revenue‑cycle functions, including Patient Access, Medical Records, Professional Billing, Collections, Hospital Collections, Revenue Enhancement, Human Resources, Information Systems, Financial Reporting, Process Improvement, Charge Entry, Training, Corporate Finance, MyVisit, and Customer Service. Develops, implements and directs quality initiatives to improve the revenue‑cycle process. Manages departmental operating and capital budgets within limits and Freedom‑To‑Act guidelines to achieve performance targets. Facilitates technological initiatives supporting coding and business process improvements. Assists with establishing training tools for all revenue‑cycle employees regarding financial business strategies and ongoing improvements. Position Details One relevant certification from AHIMA or AAPC is required upon hire. Acceptable certifications include: AHIMA (American Health Information Management Association): Certified Coding Specialist (CCS) Certified Coding Specialist – Physician‑Based (CCS‑P) Registered Health Information Technician (RHIT) Registered Health Information Administrator (RHIA) Certified Coding Associate (CCA) – candidates with only a CCA must obtain a CCS, RHIT, or RHIA within 12 months of hire. All certifications from AAPC (American Academy of Professional Coders) are acceptable except: Scribe, Documentation, Instructor, and International Credentials Certified Professional Biller (CPB) Revenue Cycle Management Specialist (RCMS) Certified Value‑Based Administrator (CVBA) Certified Physician Practice Manager (CPPM) Certified Professional Compliance Officer (CPCO) Education High School Diploma or Equivalent (GED) - Required. Experience Minimum of 5 years managerial/supervisory experience - Required. Minimum of 8 years relevant experience - Required. Work Environment Work is typically performed in an office environment. Accountable for satisfying all job‑specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all‑inclusive but represent typical elements considered necessary to successfully perform the role.

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Equal Employment Opportunity We are a proud affirmative action, equal‑opportunity employer. All qualified applicants will receive consideration for employment regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. Women and minorities are encouraged to apply. We are an affirmative action, equal‑opportunity employer and all qualified applicants will receive consideration for employment without discrimination on the basis of disability or their protected veteran status. #J-18808-Ljbffr Nahse