Overview

We are seeking a Director of Coding to join our team at UnityPoint Health! As a leader within the System Services Revenue Cycle team, the Director of Coding is responsible for the strategic, operational, and regulatory leadership of UnityPoint Health's coding functions across hospital (facility) and physician (professional) services. This role includes enterprise accountability for internal coding staff and outsources/vendor-contracted coding services, ensuring consistent quality, compliance, productivity, and financial performance. The Director partners closely with HIM, CDI, Revenue Integrity, Compliance, Finance, IT, and clinical leadership to support accurate documentation, compliant coding, and optimal reimbursement.

A primary focus includes managing the strategic partnership with external contract coding vendor(s) while leading an internal team of coding managers and specialists to meet high-performance standards. This role is responsible for maintaining a compliant coding process that follows the Official Guidelines for Coding and Reporting diagnoses and procedures for UnityPoint Health. Additionally, the Director is responsible for accurately reflecting the condition and treatments of our patients that impact reimbursement, ACO metrics, quality scores and several external reporting metrics based on the documentation in the health record.

Candidates with extensive vendor management and strong leadership skills are highly encouraged to apply.

Location: Remote - applicants must reside within the UnityPoint Health footprint of Iowa, Illinois, or Wisconsin. Some travel required.

Hours: Monday-Friday, standard business hours

Responsibilities

Operational Leadership:

• Direct all coding activities for hospital inpatient, outpatient, and professional fee services
• Monitor and manage Discharged Not Final Billed (DNFB) and Candidate for Bill (CFB) targets to ensure optimized cash flow
• Standardize coding workflows across the health system to ensure consistency between facility and professional service reporting
• Work with various leaders and providers to ensure optimal revenue attainment and complete compliance with governmental and private payer requirements
• Responsible for working with Compliance Officers and UPH Internal Audit to ensure all aspects of Coding Compliance and Coding Audits meet the overall UnityPoint Health Compliance Plan
• Monitors the activities of all operational components to ensure the department successfully meets its objectives
• Keep up to date on new statutes/regulations/policies and distribute updates
• Provide guidance in the coding/abstraction, production and quality assurance, auditing and training activities
• Trouble shoot and collaborate with other managers to problem-solve and advance the processes of the department and UnityPoint Health
• Establishes, evaluates, and revises operating policies and procedures to ensure compliance and effectiveness of the Coding Department utilizing best practices
• Establishes effective mechanisms of communication with staff, providers, payers, and UnityPoint Health leadership
• Demonstrate fiscal management of the Coding Department through comprehensive budgetary planning, variance analysis and justification while regularly monitoring financial performance and productivity
• Monitor and implement compliant and consistent coding practices
• Maintain compliance with Medicare, Medicaid, and other payer coding guidelines
• Lead, mentor and evaluate internal team of coding managers and staff

Vendor & Relationship Management:

• Develop and maintain strong, collaborative relationships with outsource vendors to ensure alignment with UnityPoint Health's values, standards and operational goals
• Act as an extension of UnityPoint Health by representing the organization's interests an ensuring vendor partners are integrated into key processes and initiatives
• Establish and hardwire clear communication channels between internal teams and external vendors to facilitate timely information sharing and issue resolution
• Oversee the management of service level agreements (SLAs), ensuring performance metrics are clearly defined, tracked and consistently met or exceeded

Compliance & Quality Assurance:

• Collaborate with the Coding Quality department to ensure internal and vendor compliance with CMS, OIG, and HIPAA regulations
• Ensure accurate assignment of ICD-10-CM/PCS, CPT, and HCPCS codes, as well as MS-DRG and APR-DRG validation
• Collaborate with the Clinical Documentation Improvement (CDI) team to bridge gaps between documentation and coding

Qualifications

Education:

• Required: Bachelor's Degree in Health Information Management
• Preferred: Master's Degree in Health Information Management, Healthcare Administration, or Business Administration

Experience:

• Required: 3-5 years direct experience with hospital coding, reimbursement methodologies and leadership experience
• Required: 7-10 years of experience in managing effective coding operations

Licenses & Certifications:

• Required: RHIA, RHIT, CCS, CCS-P, CPC or equivalent coding credentialed

Knowledge, Skills, & Abilities:

• Thorough knowledge regarding MS-DRG's, APC's, ICD-10, CPT, HCPCS coding principals, coding all patient types and official coding guidelines
• Comprehensive knowledge of billing coding requirements
• Strong analytical, communication, and executive reporting skill
• Knowledge of compliance rules and regulations
• Knowledge of quality metrics and commitment to enforcement of standards
• Ability to work independently in a fast-paced environment

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