Director, Hospital Coding

🔥 17 hours ago

🇺🇸 United States – Remote

⏰ Full Time

🔴 Lead

👔 Director

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Healthrise

WebsiteLinkedInAll Job Openings

51 - 200 employees

🏥 Healthcare

⚖️ Legal

📦 Logistics

Healthcare • Legal • Logistics

Healthrise is a company dedicated to providing comprehensive healthcare solutions, focusing on revenue cycle management, electronic health record (EHR) services, and strategic consulting. With over a decade of experience, Healthrise assists health systems nationwide in achieving operational and financial success through tailored strategies. Their team of experts partners with healthcare organizations to tackle complex operational challenges and enhance efficiency, ensuring both patient and financial outcomes are optimized.

📋 Description

• Provide domestic day-to-day management of hospital and facility coding operations across assigned clients, facilities, patient types, and service areas • Oversee account inventory, work-queue prioritization and distribution, backlog prevention and recovery, hold/suspense management, and timely-filing protection • Monitor throughput, productivity, work-queue aging, coding turnaround time, Pre-AR, edits, rework, and SLA performance; investigate variance and drive corrective action • Direct coding execution for inpatient, outpatient surgery, emergency, observation, ancillary, and series accounts • Lead daily production huddles and weekly backlog, aging, productivity, staffing, coverage, and escalation reviews • Forecast demand and coordinate capacity, patient-type coverage, surge support, and phased ramp plans • Lead, develop, and manage onshore Hospital Billing Coding Leads • Partner with global delivery leadership to coordinate assignments, staffing, coverage, issue resolution, and corrective-action evidence • Serve as primary liaison to client stakeholders for operational performance, queue health, service delivery, implementation readiness, and escalations • Coordinate onboarding, offboarding, access requests, assignments, production readiness, and go-live support • Ensure adherence to coding, payer, HIPAA, regulatory, and compliance requirements • Partner with Coding Quality on audits, calibration, denial and DRG-validation trends, error validation, and corrective actions • Own operational responses to hospital coding edits and denials, including rebills and defensible coding rationale • Produce and present daily, weekly, and monthly performance dashboards and improvement plans • Partner cross-functionally with Revenue Integrity, Compliance, CDI, IT, charging, billing, and payer-facing teams • Provide subject-matter expertise for work-queue design, routing, prioritization, reporting, automation, grouper, and billing-edit changes • Identify, pilot, and quantify process improvements using CAC, NLP, automation, analytics, and other tools • Support expansion to new clients, facilities, patient types, and service lines • Maintain project documentation, issue and escalation logs, decisions, mitigation plans, and closure evidence • Travel to client or organizational sites as required and perform other duties as assigned

🎯 Requirements

• Active hospital/facility coding credential required, such as CCS, RHIA, RHIT, CIC, or COC (AHIMA or AAPC), or equivalent • Minimum 7 years of progressive hospital or facility coding experience, including at least 3 years in coding operations leadership • Expertise 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 leading multi-facility hospital coding operations across inpatient, outpatient surgery, emergency, observation, ancillary, or related patient types, including work-queue management, capacity planning, backlog recovery, and SLA/TAT delivery • Experience directly leading onshore teams and collaborating with global delivery or third-party partners on performance, remediation, escalation, and SLA accountability • Experience with hospital coding edits, denials, provider queries, CDI collaboration, charge review/correction, rebill workflows, root-cause analysis, and corrective action • Ability to analyze operational data and translate findings into actionable staffing, workflow, training, quality, and performance recommendations • 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 minimum 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 credential 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 supporting complex facility coding services • Preferred: Lean Six Sigma certification or structured process-improvement and root-cause workshop experience • Preferred: Experience with CAC, NLP, AI-assisted coding, analytics, automation, or related technology

🏖️ Benefits

• Travel to client or organizational sites as required, including minimum quarterly travel • Healthrise Core Values-oriented work environment

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