Overview
The Director of Coding leads enterprise coding operations across HB and PB services, including PBB coding, quality assurance (QA), and training/education. This leader is accountable for accurate, timely ICD-10-CM/PCS, CPT, and HCPCS code assignment and abstracting, strong coding quality governance, audit readiness, and pre-bill edit/hold performance that reduces discharged not final coded (DNFC) and discharged not final billed (DNFB), improves claim quality, and minimizes coding-related denials and compliance risk. The Director partners with Clinical Documentation Integrity (CDI), Health Information Management (HIM), Billing/Patient Financial Services, Revenue Integrity, clinical leaders, and IT to standardize workflows, optimize encoder/computer-assisted coding (CAC) capabilities, and drive performance transparency.
Qualifications
Education: Bachelor's degree in Health Information Management, Healthcare Administration, Business Administration, Nursing, or a related field required.
- Master's degree preferred.
- Experience: Minimum of 7 years of progressively responsible experience in healthcare coding, Health Information Management (HIM), revenue cycle, or a related field.
- Minimum of 5 years of leadership experience required.
- Experience overseeing Hospital Billing (HB) and Professional Billing (PB) coding operations in an academic medical center, health system, or large integrated delivery network strongly preferred.
- Experience with:
- Provider-based billing
- Epic
- Coding quality programs
- Denial management
- Audit response processes
- Regulatory compliance initiatives
- License/Certification/Registration: One of the following nationally recognized coding certifications is required and must be maintained in good standing:
- RHIA (Registered Health Information Administrator)
- RHIT (Registered Health Information Technician)
- CCS (Certified Coding Specialist)
- CCS-P (Certified Coding Specialist - Physician-based)
- CPC (Certified Professional Coder)
- COC (Certified Outpatient Coder)
- CIC (Certified Inpatient Coder)
- CPMA (Certified Professional Medical Auditor)
- Equivalent nationally recognized coding certification
- Additional leadership, auditing, compliance, or revenue cycle certifications preferred.
- Demonstrated expertise in:
- Team leadership and talent development
- Staff coaching and succession planning
- Performance management and accountability
- Proven ability to collaborate effectively with:
- Clinical Documentation Integrity (CDI)
- Health Information Management (HIM)
- Revenue Integrity
- Billing Operations
- Information Technology (IT)
- Executive-ready communication skills, including:
- Written communication
- Verbal communication
- Facilitation and presentation skills
- Strong change leadership and continuous improvement mindset driven by data and performance outcomes.
- Demonstrated performance management discipline, including:
- Key Performance Indicators (KPIs)
- Operational cadence
- Accountability frameworks
- Experience providing enterprise coding governance leadership across complex healthcare organizations.
- Strong operational discipline balancing:
- Productivity
- Coding quality
- Compliance risk management
- Deep knowledge of:
- ICD-10-CM
- ICD-10-PCS
- CPT coding
- HCPCS coding
- Modifier assignment guidelines
- Strong command of:
- Official coding guidelines
- Government and commercial payer policies
- Regulatory coding requirements
- Expertise in:
- MS-DRG reimbursement methodologies
- APC/OPPS reimbursement logic
- Facility coding requirements
- Professional coding conventions
- Extensive knowledge of:
- Coding quality assurance programs
- Coding audit practices
- Audit defense preparation
- Coding-related denial prevention and resolution
- Working knowledge of:
- National Correct Coding Initiative (NCCI) edits
- Claim edit processes
- Pre-bill hold concepts
- Revenue cycle claim validation workflows
- Proficiency with:
- Encoder software
- Computer-Assisted Coding (CAC) platforms
- Work queue management systems
- Coding analytics tools
- Reporting platforms
- Strong analytical, organizational, compliance, and leadership skills with a focus on operational excellence, coding accuracy, and regulatory integrity.