Director, Coding Quality Assurance – Education

This is a fully remote position, open to applicants in United States.

📋 Description

• Establish and lead the enterprise strategy, governance framework, and operational model for coding quality assurance, auditing, education, and validation across Hospital Billing and Professional Billing.

• Provide executive oversight for routine, focused, compliance-driven, and risk-based coding audit programs.

• Approve and uphold audit methodologies, sampling standards, scoring protocols, quality thresholds, escalation criteria, and remediation expectations.

• Analyze trends in coding quality, risk indicators, and performance results while advising senior leadership.

• Ensure corrective actions, remediation, re-audits, and processes for sustained improvement in response to significant findings.

• Lead assigned managers, Coding Auditor/Educator staff, and other quality resources.

• Develop and guide enterprise coding education, providing onboarding, continuing education, and competency strategies.

• Establish career development pathways and facilitate professional development and succession planning.

• Oversee external coding audits, independent reviews, specialty assessments, and coding quality evaluations.

• Set quality requirements and performance metrics for external coding partners and vendors.

• Collaborate with Compliance and Coding leadership on reviews, regulatory changes, investigations, risk assessments, and corrective action plans.

• Supervise quality monitoring and validation for computer-assisted, AI-assisted, autonomous, and other emerging coding technologies.

• Partner with Epic/Information Technology, Compliance, Coding, clinical and operational stakeholders, and technology vendors.

• Create coding quality dashboards, KPIs, executive reporting, and benchmarking methodologies.

• Develop annual and long-term priorities, resource plans, staffing models, vendor utilization, budget considerations, technology needs, and strategic initiatives.

⛳️ Requirements

• Bachelor's degree in Health Information Management, Health Information Administration, Healthcare Administration, Business Administration, or a related field, along with five (5) years of progressive experience in medical coding, coding auditing, coding quality assurance, coding education, compliance, or a related revenue cycle function; OR an Associate’s Degree in Health Information Technology and seven (7) years of relevant experience; OR a high school diploma and ten (10) years of relevant experience along with an active coding certification from AHIMA or AAPC.

• Minimum of three (3) years of leadership experience with responsibilities for coding quality, auditing, education, compliance, or a related revenue cycle function.

• In-depth knowledge of ICD-10-CM, ICD-10-PCS, CPT, HCPCS, official coding guidelines, reimbursement methodologies, payer requirements, and applicable regulatory standards.

• Advanced expertise in coding quality assurance, audit methodology, healthcare reimbursement, compliance principles, documentation requirements, and revenue integrity practices.

• Proven ability to lead enterprise programs, establish governance, translate strategic priorities into operational plans, and drive measurable performance improvements.

• Strong analytical and critical-thinking capabilities for interpreting coding quality data, recognizing trends and risks, and formulating recommendations.

• Leadership skills including team development, coaching, performance management, succession planning, change leadership, and managing through other leaders.

• Exceptional written, verbal, presentation, and executive communication skills.

• Ability to forge partnerships across Coding, Compliance, Revenue Cycle, Information Technology, Finance, clinical, operational, and vendor teams.

• Capacity to assess coding technology, automation, vendor performance, and emerging industry practices.

• Prolonged periods of sitting and working on a computer; frequent use of hands and fingers to operate computers and office equipment; ability to communicate through verbal, written, virtual, and electronic means.

🏝️ Benefits

• Standard office or remote work environment.

• Occasional travel to WVU Medicine facilities or other locations for meetings, leadership activities, training, audits, or operational needs.

• Reasonable accommodations may be made for individuals with disabilities.

• 40 scheduled weekly hours.

• Exempt position.