Program Director – Coding HB

This is a fully remote position, open to applicants in New Jersey.

📋 Description

• Provide strategic and operational direction for hospital coding and billing initiatives.

• Create program strategies, operational models, workflows, performance standards, and implementation plans.

• Establish key performance indicators (KPIs), goals, and performance expectations for the program.

• Monitor program performance, developing corrective actions and improvement strategies as needed.

• Identify avenues for enhancing coding accuracy, reimbursement rates, productivity, quality, and financial results.

• Formulate scalable processes and best practices applicable to multiple clients.

• Serve as a subject matter expert in hospital inpatient and outpatient coding and billing.

• Assess coding and billing workflows, operational deficiencies, accuracy, productivity, quality, reimbursement, and compliance trends.

• Analyze documentation, coding, billing, reimbursement, denials, charge capture, claim submissions, edits, billing workflows, and payer requirements.

• Collaborate with Clinical Documentation Improvement (CDI), coding, utilization review, denials, and revenue cycle teams.

• Act as a senior client-facing leader and trusted advisor.

• Lead operational assessments, client meetings, executive presentations, and performance evaluations.

• Generate data-driven recommendations and convert complex coding and revenue cycle challenges into actionable business insights.

• Manage client escalations and discover opportunities to enhance client relationships.

• Analyze the overall hospital revenue cycle to pinpoint improvement opportunities, revenue leakage, and reimbursement enhancements.

• Support initiatives aimed at clean claims, reducing denials, accelerating reimbursements, and increasing net revenue.

• Review operational, coding, billing, and financial data; create dashboards and performance reports.

• Set baselines, targets, and actionable recommendations with analytical resources.

• Oversee the implementation of coding, billing, and revenue cycle programs.

• Develop project plans, timelines, milestones, and deliverables; coordinate cross-functional teams effectively.

• Identify risks, establish mitigation strategies, and communicate project status to executives and clients.

• Ensure adherence to federal and state regulations, payer requirements, and client policies.

• Monitor coding quality and compliance; assist with audits; develop quality assurance and monitoring procedures.

• Provide functional leadership and mentorship to coding, billing, and revenue cycle professionals.

• Set performance expectations, support educational programs, identify training needs, and advocate for continuous improvement.

⛳️ Requirements

• Bachelor’s degree in Health Information Management, Healthcare Administration, Business, Finance, or a related field; equivalent experience may be accepted.

• Over 7 years of progressive experience in hospital coding, billing, Health Information Management (HIM), revenue cycle, or healthcare financial operations.

• At least 3 years of leadership or program management experience.

• In-depth knowledge of hospital inpatient and outpatient coding.

• Strong understanding of hospital billing and revenue cycle operations.

• Experience collaborating with healthcare clients, hospitals, health systems, or physician organizations.

• Proven experience in analyzing operational and financial performance.

• Experience leading process improvement or revenue cycle initiatives.

• Strong understanding of payer requirements and reimbursement methodologies.

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

• Demonstrated ability to manage complex projects and cross-functional teams.

• Preferred: RHIA, RHIT, CCS, CPC, COC, or other relevant HIM/coding certifications.

• Preferred: Experience with Epic or other significant Electronic Health Record (EHR) platforms.

• Preferred: Familiarity with encoder, Computer-Assisted Coding (CAC), Clinical Documentation Improvement (CDI), billing, or revenue cycle technology.

• Preferred: Experience with Power BI or other healthcare analytics tools.

• Preferred: Experience in handling hospital denials and appeals.

• Preferred: Experience with revenue integrity.

• Preferred: Experience collaborating with outsourced coding or revenue cycle organizations.

• Preferred: Experience managing multi-client or national healthcare programs.

🏝️ Benefits

• Full-Time employment.

• Remote work arrangement.