Director, Hospital Coding

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

📋 Description

• Manage the day-to-day coding operations for hospitals and facilities across designated clients, facilities, patient categories, and service areas.

• Supervise account inventory, prioritize and distribute work queues, prevent and recover backlogs, manage holds/suspense, and ensure timely filing protections.

• Track throughput, productivity, work queue aging, coding turnaround time, Pre-AR, edits, rework, and SLA performance; analyze variances and implement corrective actions.

• Direct coding activities for inpatient, outpatient surgery, emergency, observation, ancillary, and series accounts.

• Facilitate daily production meetings and conduct weekly reviews on backlog, aging, productivity, staffing, coverage, and escalations.

• Anticipate demand and organize capacity, patient-type coverage, surge support, and phased ramp plans.

• Lead, develop, and oversee onshore Hospital Billing Coding Leads.

• Collaborate with global delivery leadership to manage assignments, staffing, coverage, issue resolution, and evidence of corrective actions.

• Act as the primary point of contact for client stakeholders regarding operational performance, queue health, service delivery, implementation readiness, and escalations.

• Organize onboarding, offboarding, access requests, assignments, production preparedness, and go-live support.

• Ensure compliance with coding, payer, HIPAA, regulatory, and compliance standards.

• Collaborate with Coding Quality on audits, calibration, denial and DRG-validation trends, error validation, and remedial actions.

• Manage operational responses to hospital coding edits and denials, including rebills and defensible coding justifications.

• Generate and present daily, weekly, and monthly performance dashboards and improvement strategies.

• Partner cross-functionally with Revenue Integrity, Compliance, CDI, IT, charging, billing, and payer-facing teams.

• Provide expertise in work queue design, routing, prioritization, reporting, automation, grouper, and billing edit modifications.

• Identify, pilot, and assess process enhancements utilizing CAC, NLP, automation, analytics, and other tools.

• Assist in the expansion to new clients, facilities, patient categories, and service lines.

• Maintain project documentation, issue and escalation logs, decisions, mitigation strategies, and closure evidence.

• Travel to client or organizational sites as necessary and perform other assigned duties.

⛳️ Requirements

• An active hospital/facility coding credential is required, such as CCS, RHIA, RHIT, CIC, or COC (AHIMA or AAPC), or an equivalent qualification.

• A minimum of 7 years of progressive experience in hospital or facility coding, including at least 3 years in coding operations leadership.

• Proficiency in ICD-10-CM/PCS, CPT, HCPCS, POA, MS-DRG/APR-DRG, APC, NCCI edits, medical necessity, clinical validation, revenue codes, modifiers, and facility coding workflows.

• Experience in leading multi-facility hospital coding operations across various patient types, including work queue management, capacity planning, backlog recovery, and SLA/TAT delivery.

• Proven experience in directly leading onshore teams and collaborating with global delivery or third-party partners on performance, remediation, escalation, and SLA accountability.

• Familiarity with hospital coding edits, denials, provider queries, CDI collaboration, charge review/correction, rebill workflows, root-cause analysis, and corrective actions.

• Capable of analyzing operational data and converting findings into actionable recommendations for staffing, workflow, training, quality, and performance.

• Strong project management, client relationship, written communication, and executive presentation skills.

• Completion of regulatory and mandatory certifications as required.

• Willingness and ability to travel to client or organizational sites as needed, including a minimum of quarterly travel.

• Preferred: Bachelor's or master's degree in health information management, healthcare administration, business, or a related field.

• Preferred: Additional audit, CDI, compliance, or revenue-cycle credentials such as CDIP, CCDS, CPMA, CPCO, CRCR, or FHFMA.

• Preferred: Experience with Epic Hospital Billing/Resolute work queues, reporting, charge review, coding and billing edits, and related workflow tools.

• Preferred: Experience in supporting complex facility coding services.

• Preferred: Lean Six Sigma certification or experience with structured process improvement and root-cause workshops.

• Preferred: Experience with CAC, NLP, AI-assisted coding, analytics, automation, or related technologies.

🏝️ Benefits

• Travel to client or organizational sites as necessary, including a minimum of quarterly travel.

• A work environment aligned with Healthrise Core Values.