Director, Coding Quality Assurance – Education

🔥 2 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🔴 Lead

🔧 QA Engineer (Quality Assurance)

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WVU Medicine

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

WVU Medicine is a comprehensive health system affiliated with West Virginia University, providing medical services through a network of hospitals across West Virginia. The system includes notable facilities such as J. W. Ruby Memorial Hospital, WVU Medicine Children's, and various other regional medical centers. WVU Medicine offers a wide range of healthcare services, including specialized and advanced medical treatments such as robotic heart surgery. It's also involved in medical education, research, and community health initiatives, emphasizing a mission of delivering high-quality care to the communities it serves.

📋 Description

• Establish and direct enterprise strategy, governance framework, and operating model for coding quality assurance, audit, education, and validation across Hospital Billing and Professional Billing • Provide executive oversight of routine, focused, compliance-directed, and risk-based coding audit programs • Approve and maintain audit methodologies, sampling standards, scoring protocols, quality thresholds, escalation criteria, and remediation expectations • Analyze coding quality trends, risk indicators, and performance results and advise senior leadership • Ensure corrective action, remediation, re-audit, and sustained-improvement processes for significant findings • Lead assigned managers, Coding Auditor/Educator staff, and other quality resources • Develop and direct enterprise coding education, guidance, onboarding, continuing education, and competency strategies • Establish career development pathways and support professional development and succession planning • Direct external coding audits, independent reviews, specialty reviews, and coding quality assessments • Establish quality requirements and performance measures for external coding partners and vendors • Partner with Compliance and Coding leadership on reviews, regulatory changes, investigations, risk assessments, and corrective action plans • Oversee quality monitoring and validation for computer-assisted, AI-assisted, autonomous, and other emerging coding technologies • Partner with Epic/Information Technology, Compliance, Coding, clinical and operational stakeholders, and technology vendors • Establish coding quality dashboards, KPIs, executive reporting, and benchmarking methodologies • Develop annual and long-range priorities, resource plans, staffing models, vendor utilization, budget considerations, technology needs, and strategic initiatives

🎯 Requirements

• Bachelor's degree in Health Information Management, Health Information Administration, Healthcare Administration, Business Administration, or related field and five (5) years of progressive experience in medical coding, coding auditing, coding quality assurance, coding education, compliance, or a related revenue cycle function; OR Associate’s Degree in Health Information Technology and seven (7) years of such experience; OR high school diploma and ten (10) years of such experience plus active coding certification from AHIMA or AAPC • Three (3) years of leadership experience with responsibility for coding quality, auditing, education, compliance, or a related revenue cycle function • Expert knowledge of ICD-10-CM, ICD-10-PCS, CPT, HCPCS, official coding guidelines, reimbursement methodologies, payer requirements, and applicable regulatory standards • Advanced knowledge of coding quality assurance, audit methodology, healthcare reimbursement, compliance principles, documentation requirements, and revenue integrity practices • Demonstrated ability to lead enterprise programs, establish governance, translate strategic priorities into operational plans, and drive measurable performance improvement • Strong analytical and critical-thinking skills for interpreting coding quality data, identifying trends and risks, and developing recommendations • Leadership ability including team development, coaching, performance management, succession planning, change leadership, and management through other leaders • Excellent written, verbal, presentation, and executive communication skills • Ability to build partnerships across Coding, Compliance, Revenue Cycle, Information Technology, Finance, clinical, operational, and vendor teams • Ability to evaluate coding technology, automation, vendor performance, and emerging industry practices • Prolonged sitting and computer work; frequent use of hands and fingers to operate computers and office equipment; ability to communicate through verbal, written, virtual, and electronic means

🏖️ Benefits

• Standard office or remote work environment • Occasional travel to WVU Medicine facilities or other locations for meetings, leadership activities, training, audits, or operational needs • Reasonable accommodations may be made for individuals with disabilities • 40 scheduled weekly hours • Exempt position