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.