Coding Leader

Job Description

Job Description

Description:

We are seeking an experienced leader to join our team in a consultative, hands-on capacity to support client engagements focused on evaluating and optimizing charging and coding practices across hospital and professional service lines. This individual will serve as a subject matter expert in clinical coding and/or revenue integrity/charge capture, leading assessments and initiatives that drive compliance, accuracy, and revenue integrity across client engagements.

The leader will partner with client stakeholders to analyze current-state workflows, validate coding accuracy, and implement actionable recommendations that strengthen mid-cycle performance as well as front and back-end performance. This role is ideal for a hands-on professional who thrives in a fast-paced consulting environment and can translate regulatory requirements into operational improvements.

This leader will serve as a key driver of sustainable mid-cycle improvements that enhance accuracy, standardization, and financial integrity across client organizations.

DUTIES AND RESPONSIBILITIES

Key Responsibilities:

• Knows, understands, incorporates, and demonstrates the Healthrise Core Values in all interactions with team members, clients, and stakeholders.
• Perform detailed assessments of charging and coding practices across facility and/or professional services (i.e., complex service lines such as cardiology and neurosurgery, ASCs and IP/OP facility) to identify compliance risks, revenue leakage, and process inefficiencies.
• Evaluate Charge Description Master (CDM) structure, charge capture workflows, and coding alignment with DRG, CPT, HCPCS, ICD-10, and payer-specific requirements.
• Analyze documentation, coding patterns, and charge utilization to identify optimization opportunities and root causes of revenue variance.
• Validate inpatient coding accuracy, including MS-DRG and APR-DRG assignment, principal diagnosis selection, POA indicators, and SOI/ROM capture, to ensure compliant case-mix and reimbursement integrity.
• Develop structured findings, gap analyses, and prioritized recommendations aligned to regulatory guidance and industry best practices.
• Lead project workstreams focused on implementation of charging and coding improvements, including workflow redesign, charge capture controls, and CDM updates.
• Partner with client operational leaders, revenue integrity teams, compliance, and clinical departments to support adoption of recommended changes.
• Translate complex regulatory requirements into practical operational guidance.
• Support development of executive-level summaries outlining financial impact, compliance exposure, and implementation roadmap.
• Support response to inpatient coding-related denials and external audits (RAC, MAC, payer DRG validation), including rebuttal development and root-cause remediation.
• Collaborate with cross-functional teams to ensure alignment between clinical documentation, coding, and charge capture processes.
• Partner with Clinical Documentation Integrity (CDI) teams to address documentation gaps affecting inpatient code assignment, query practices, and DRG accuracy.
• Utilize Epic and/or other EHR reporting tools to validate charge logic, identify trends, and support data-driven recommendations.
• Maintain project documentation including status updates, issue tracking, and mitigation strategies.
• Travel to client or organizational sites as required to support on-the-ground project execution.
• Performs other duties as assigned.

QUALIFICATIONS

Required:

• Active coding credential required, such as CCS, CCS-P, CPC, COC, CIC, RHIA, or RHIT (AHIMA or AAPC), or equivalent.
• Demonstrated hands-on coding experience, with specialty expertise in cardiology and/or neurosurgery.
• Prior experience leading or participating in charging assessments and CDM reviews.
• Strong project management skills with the ability to manage multiple initiatives simultaneously.
• Experience presenting to and communicating with executive-level audiences.
• Proficiency in Epic required.
• Demonstrated experience leading and managing blended coding teams across onshore and offshore resources, including direct oversight of third-party coding vendors (performance management, quality oversight, and SLA accountability).
• Proficiency in Epic or comparable EHR systems, including reporting functionality.
• Ability to interpret data and translate findings into actionable operational recommendations.
• Strong written and verbal communication skills with ability to present findings to operational and executive stakeholders.
• Ability to manage multiple workstreams in a project-based environment.
• Willingness and ability to travel as needed, minimum quarterly travel.
• Completion of regulatory/mandatory certifications as required.

Preferred:

• Master's degree (MHA, MBA, or equivalent).
• Certified Professional Coder (CPC), Certified Revenue Cycle Professional (CRCP), HFMA Fellow (FHFMA), or equivalent industry certification.
• Lean Six Sigma Green Belt or Black Belt; demonstrated experience facilitating rapid improvement events (Kaizen, RCA workshops).
• Experience with AI/automation tools applied to revenue cycle (RPA, AI-assisted coding, intelligent denial routing).
• Familiarity with No Surprises Act, price transparency requirements, and other recent regulatory developments affecting hospital and physician billing.

PHYSICAL DEMANDS AND WORK ENVIRONMENT

Work Environment: Operates in a variety of professional settings — corporate offices, client hospitals and health system campuses, remote home office, and travel environments. Must be comfortable adapting to new physical and technological environments quickly and frequently.

Physical Demands: This is largely a sedentary role; however, employees may need to use keyboards, mouse, and other devices for typing, clicking, and navigating software systems.

Schedule: Standard business hours with flexibility required during crisis deployments, go-live activations, or client-driven escalations. Occasional evening or weekend availability may be required in high-urgency situations.