Job Summary:

Location: Methodist Corporate Office
Address: 825 S 169th St. - Omaha, NE

Provides strategic leadership and oversight for revenue cycle operations related to coding, clinical documentation, and health information management across Nebraska Methodist Hospital. Responsible for Clinical Documentation Improvement (CDI), Utilization Management, Tumor Registry, Health Information Management (HIM), and Transcription Services, ensuring regulatory compliance, operational efficiency, and the integrity of the legal medical record. Collaborates with leaders across the revenue cycle, affiliates, legal, and compliance functions to optimize processes, support reimbursement accuracy, and maintain adherence to accreditation and regulatory standards.

Responsibilities:

Essential Functions

Directs coding for Nebraska Methodist Hospitals and hospital-based outpatient clinics (System Wide) (35%)

• Manages internal and external coding resources to ensure the timely, accurate, and compliant assignment of diagnoses and procedures, supporting appropriate severity of illness and intensity of service capture.

• Oversees concurrent coding activities in partnership with the Clinical Documentation Improvement (CDI) team to enhance documentation accuracy and optimize reimbursement.

• Directs the administration, maintenance, and optimization of coding software, encoders, computer-assisted coding (CAC) tools, and related system applications.

• Establishes and monitors coding quality and productivity standards, ensuring staff performance meets or exceeds organizational expectations.

• Ensures coding compliance through ongoing monitoring, education, and periodic internal and external audits, implementing corrective actions as needed.

• Leverages advanced coding technologies and automation tools to improve coding accuracy, completeness, efficiency, and regulatory compliance.

• Oversees the full lifecycle of Recovery Audit Contractor (RAC) and Targeted Probe and Educate (TPE) audits, including audit tracking, documentation collection, response preparation, coordination with clinical and revenue cycle teams, appeal support, and adherence to CMS requirements and submission deadlines.

Clinical Documentation Improvement (CDI) (20%)

• Provides leadership and oversight of the Clinical Documentation Improvement (CDI) program, ensuring completion of daily concurrent and follow-up reviews, timely physician query resolution, ongoing provider education, and collaboration with coding staff to support accurate DRG assignment and reimbursement.

• Builds and maintains a high-performing CDI team capable of effectively engaging physicians and other clinical practitioners to improve documentation quality and accuracy.

• Develops and delivers physician education initiatives to ensure clinical documentation accurately reflects patient acuity, severity of illness, risk of mortality, quality outcomes, and resource utilization.

• Oversees staff training, competency development, quality assurance reviews, and onboarding/orientation programs for new physicians and clinical practitioners related to documentation and coding best practices.

• Champions industry best practices in clinical documentation integrity, promoting accurate and complete capture of patient care that supports compliant coding, quality reporting, and reimbursement outcomes.

• Analyzes and monitors key performance indicators, including case mix index (CMI), severity of illness (SOI), risk of mortality (ROM), and CC/MCC capture rates, identifying trends and opportunities for targeted physician and coder education and process improvement.

Oversees Utilization Management for hospitals (20%)

• Provides leadership and oversight of utilization management processes to ensure timely acquisition and extension of payer authorizations, supporting appropriate reimbursement and continuity of care.

• Collaborates with commercial, government, and other third-party payers to facilitate authorization approvals, resolve coverage issues, and ensure compliance with payer requirements.

• Oversees the provision of clinical review information that accurately reflects the patient's condition, treatment plan, level of care, and medical necessity to support authorization and reimbursement decisions.

• Partners with clinical, case management, and revenue cycle teams to optimize utilization review practices, minimize authorization denials, and improve financial and operational outcomes.

Supports management of the Methodist Cancer Registry (5%)

• Provides oversight for the implementation, maintenance, and optimization of the enterprise-wide, multi-facility cancer registry database, ensuring data integrity, standardization, and regulatory compliance across all entities.

• Ensures compliance with accreditation standards established by applicable cancer program accrediting bodies, provides accurate and timely data to cancer committees, and supports educational initiatives related to oncology data management and quality improvement.

• Directs the collection, abstraction, validation, and submission of cancer data for all eligible cases in accordance with state, national, and regulatory reporting requirements, ensuring completeness, accuracy, and timeliness of submissions to cancer registries and other required agencies.

Schedule:

Full time

Job Description:

Job Requirements

Education

• Requires Bachelor's degree in Nursing, Health Information Management or Healthcare related field.

• Master's degree preferred.

Experience

• Minimum of 7-10 years progressive experience in hospital/health care setting.

• Minimum of 10 years of management experience.

• Recent experience in a hospital, health system or large multi-specialty physician group setting.

• Demonstrated track record of mentoring teams resulting in higher level of job satisfaction and performance.

• Minimum 5 years' experience managing different components of the Revenue Cycle preferred.

License/Certifications

• Current valid Registered Nurse (RN) license, valid compact multistate license, or a temporary permit while awaiting licensure required.

• Or

• Certified as a Registered Health Information Administrator(RHIA) required.

Skills/Knowledge/Abilities

• Knowledge of rules and regulations regarding registration, the legal medical record and release of information.

• Proficient DRG, ICD-10, CPT-4 medical record coding, UB04/CMS-1500 claim billing.

• Knowledge of revenue cycle accounting concepts.

• Proficiency in Health Information Systems, coding technology, and various other system applications related to coding and clinical documentation.

• Ability to work independently.

• Ability to effectively manage uncertainty and complex situations.

• Ability to motivate a high performing team.

• Demonstrates a sense of urgency.

• Ability to identify, analyze and effectively address complex issues.

• Ability to establish positive working relationship with a variety of departments/individuals and promote collaboration. Position requires a strong positive working relationship with medical staff.

Physical Requirements

Weight Demands

• Light Work - Exerting up to 20 pounds of force.

Physical Activity

• Not necessary for the position (0%):

  • Balancing

  • Carrying

  • Climbing

  • Crawling

  • Crouching

  • Kneeling

  • Lifting

  • Pulling/Pushing

  • Standing

  • Stooping/bending

  • Twisting

• Occasionally Performed (1%-33%):

  • Distinguish colors

  • Grasping

  • Walking

• Frequently Performed (34%-66%):

  • Keyboarding/typing

  • Reaching

  • Repetitive Motions

  • Sitting

  • Speaking/talking

• Constantly Performed (67%-100%):

  • Hearing

  • Seeing/Visual

Job Hazards

• Not Related:

  • Chemical agents (Toxic, Corrosive, Flammable, Latex)

  • Biological agents (primary air born and blood born viruses) (Jobs with Patient contact) (BBF)

  • Physical hazards (noise, temperature, lighting, wet floors, outdoors, sharps) (more than ordinary office environment)

  • Equipment/Machinery/Tools

  • Explosives (pressurized gas)

  • Electrical Shock/Static

  • Radiation Alpha, Beta and Gamma (particles such as X-ray, Cat Scan, Gamma Knife, etc)

  • Radiation Non-Ionizing (Ultraviolet, visible light, infrared and microwaves that causes injuries to tissue or thermal or photochemical means)

  • Mechanical moving parts/vibrations