Director of Coding & CDI

POSITION SUMMARY

The Director of Coding and CDI will provide strategic leadership and operational oversight for system-wide documentation integrity and all inpatient and outpatient soft coding functions across acute and ambulatory settings. This role ensures clinical data accurately reflects patient complexity, supports appropriate reimbursement, and maintains strict compliance with federal, state, and payer regulations. Serving as a primary liaison between Revenue Cycle, Revenue Integrity, Physician Advisors, and Quality teams, the Director drives innovation, integrity, and performance improvement across the enterprise.

The Director will have a deep knowledge of ICD-10-CM/PCS, CPT-4, HCPCS Level II, and applicable coding regulations. Strong understanding of healthcare reimbursement methodologies, revenue cycle operations, and payer contracting. Proficiency with EHR systems (Oracle) and CDI/coding technology platforms (3M, Nuance, Optum, etc.). They will need the ability to build collaborative relationships with clinical, operational, and executive stakeholders. The Director will need to be Proficient in data analysis tools and presenting performance dashboards to leadership.

Key Responsibilities

Strategic Leadership & Operations

• Performance Management: Define and monitor KPIs for inpatient, ambulatory surgery (ASC), and outpatient coding operations, including coding quality metrics and productivity benchmarks.
• Operational Oversight: Manage all medical coding activities (ICD-10-CM/PCS, CPT-4, HCPCS) and oversee third-party or offshore coding vendors for contract compliance.
• Efficiency & Technology: Leverage EHR (Oracle/Epic) and encoding platforms (Solventum/3M) to automate workflows and optimize DNFB management and charge capture.
• Policy Governance: Establish and maintain policies that uphold regulatory standards and safeguard data integrity within the EHR in alignment with AHIMA, ACDIS, and AAPC standards.

Clinical Documentation Integrity (CDI)

• Program Leadership: Lead enterprise-wide CDI efforts, including concurrent/retrospective reviews to support accurate DRG assignment, HCC capture, and quality reporting (Vizient, USNWR).
• Documentation Improvement: Drive the query management process inpatient and outpatient, tracking physician agreement rates and outcomes.
• Clinical Education: Partner with Physician Advisors, Surgeons, and Hospitalists to deliver education on medical necessity and CMS Conditions of Participation.
• Focus efforts on moving inpatient accounts from Zero to One CC/MCC to accurately reflect patient severity prior to claim release.

Collaboration & Denials Management

• Cross-Functional Partnership: Act as a bridge between clinical staff and management to align documentation with patient care goals.
• Revenue Protection: Collaborate with Revenue Integrity and PA advisors to reduce clinical denials and improve hospital quality scores through clinical validation.

This position supports organizational goals by providing quality customer service, participating in performance improvement efforts and demonstrating a commitment to team work and cooperation.

QUALIFICATIONS/EDUCATION: Bachelor's degree in healthcare administration, Nursing, or Business/Finance required. Master's degree (MBA, MHA, or Organizational Leadership) preferred or in process.

LICENSE/CERTIFICATION: Coding, inpatient and outpatient certification and/or CDI certification required upon hire or transfer.

• Inpatient Coding: CCS (AHIMA), CIC (AAPC)
• Outpatient Coding: CCS-P (AHIMA), CPC, or COC (AAPC),
• CDI: CDIP (AHIMA) or CCDS (ACDIS), CDEO (AAPC), CDEI AAPC)

EXPERIENCE: Minimum 15 years leadership/management experience and of varied experience in acute hospital and outpatient surgical services, professional billing etc.

Candidate must possess excellent written and oral communication skills.

PERFORMANCE EXPECTATIONS

Demonstrates the technical competencies as established on the Assessment and Evaluation Tool.

WORK ENVIRONMENT

This position requires near visual acuity, finger and hand dexterity and light lifting (20 pounds and under) occasionally. This position requires walking, bending, reaching and stooping when accessing files and supplies.

The essential functions for this position are listed on the Assessment and Evaluation Tool.

REPORTING RELATIONSHIP

This position reports to Department leadership and supervises incumbents as assigned.

The above statement reflects the general details considered necessary to describe the principal functions of the job as identified and shall not be considered as a detailed description of all work requirements that may be inherent in the position.

Total Rewards at AtlantiCare

At AtlantiCare, we believe in supporting the whole person. Our market-competitive Total Rewards package is designed to promote the physical, emotional, social, and financial well-being of our team members. We offer a comprehensive suite of benefits and resources, including:

Generous Paid Time Off (PTO)

Medical, Prescription Drug, Dental & Vision Insurance

Retirement Plans with employer contributions

Short-Term & Long-Term Disability Coverage

Life & Accidental Death & Dismemberment Insurance

Tuition Reimbursement to support your educational goals

Flexible Spending Accounts (FSAs) for healthcare and dependent care

Wellness Programs to help you thrive

Voluntary Benefits, including Pet Insurance and more

Benefits offerings may vary based on position and are subject to eligibility requirements.

Join a team that values your well-being and invests in your future.