Coding System Professional 3 - Health Information - FT Days

University of California, Irvine•Orange, CA

7d•Onsite

About The Position

The incumbent supervises the development, enhancement, optimization, validation, and ongoing support of network coding applications and related health information technologies, with a primary focus on the organization's network coding platform and associated applications (e.g., Solventum, Cirius, SmarterDx, CAC technologies, CDI applications, and other coding and reimbursement systems). Independently manages large functional areas of the network coding application environment. Applies advanced expertise in ICD-10-CM/PCS, CPT, HCPCS, and official coding and reimbursement guidelines to evaluate, configure, and optimize coding system functionality based on operational, regulatory, and business requirements. Facilitate strategic decisions and operational initiatives that impact coding compliance, reimbursement integrity, revenue cycle performance, quality reporting, and regulatory reporting across the network. Participates in the analysis, design, implementation, integration, and maintenance of network coding applications and their interfaces with the electronic health record and other clinical and financial systems. Leads the development and oversight of system validation rules, automation, and coding edits to ensure compliant and accurate code assignment, while collaborating with coding operations, clinical documentation integrity, information technology, vendors, and other network stakeholders to evaluate user feedback, identify system enhancement opportunities, and implement solutions that improve coding accuracy, compliance, and operational efficiency. Working collaboratively with Health Information Management (HIM), Revenue Integrity (RI), Clinical Documentation Integrity (CDI), Patient Financial Services (PFS), Information Technology (IT), and other operational stakeholders, the professional evaluates departmental and interdepartmental workflows to identify opportunities for sustainable process improvement. This role leverages expertise in coding regulations, reimbursement methodologies, and external reporting requirements, including HCAI, AHRQ, Vizient, and CMS quality programs—to ensure workflow and system design decisions support accurate coding, reimbursement, regulatory reporting, and organizational performance across the network.

Requirements

Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), or Certified Coding Specialist (CCS).
Must demonstrate customer service skills appropriate to the job.
Minimum of five (5) years of progressively responsible experience in acute care inpatient and/or outpatient facility coding, coding compliance, coding quality, coding technology, health information management, or revenue cycle operations.
Experience evaluating coding workflows, analyzing business and regulatory requirements, and translating operational needs into system configurations, validation rules, edits, automation, and workflow enhancements.
Experience developing or maintaining automated coding edits or clinical decision support.
Experience collaborating with Information Technology, Health Information Management, Revenue Cycle, Clinical Documentation Integrity, clinical operations, software vendors, and executive leadership to implement network coding solutions and resolve complex system issues.
Excellent written and verbal communication skills in English.
Excellent analytical, organizational, project management, written, and verbal communication skills with the ability to lead cross-functional initiatives, facilitate stakeholder engagement, and communicate complex technical and regulatory concepts to diverse audiences.
Demonstrated expertise utilizing network coding applications and technologies, including computer-assisted coding (CAC), clinical documentation integrity (CDI), coding workflow, reimbursement optimization, and coding quality platforms such as Solventum, Cirius, SmarterDx, Epic, and other network coding or revenue cycle applications.
Demonstrated ability to independently manage multiple complex initiatives, establish priorities, meet project deadlines, and function as the network subject matter expert for coding application functionality, compliance, and system optimization.
Demonstrated ability to analyze complex coding, reimbursement, compliance, and operational issues using data analytics and reporting tools to identify trends, develop recommendations, and implement network-wide solutions.
Associate’s degree in Health Information Management, Healthcare Administration, Business Administration, or a related healthcare field.
Advanced knowledge of ICD-10-CM, ICD-10-PCS, CPT, HCPCS Level II, Official Coding Guidelines, Coding Clinic, CMS reimbursement methodologies (MS-DRG, APR-DRG, OPPS/APC), National Correct Coding Initiative (NCCI), Medicare Outpatient Code Editor (OCE), and applicable federal and state coding and reimbursement regulations.
Ability to maintain a work pace appropriate to the workload.
Must be able to provide proof of work authorization.

Nice To Haves

Knowledge of healthcare interoperability standards, system interfaces, and data exchange between electronic health records, coding applications, billing systems, and third-party vendors.
Knowledge of University and Medical Center organizations, policies, procedures and forms.
Experience working in a large, integrated, multi-hospital healthcare system with network-wide coding and revenue cycle operations.
Experience utilizing business intelligence and analytics tools such as Microsoft Power BI, SQL, Tableau, or similar platforms to evaluate coding performance, compliance, reimbursement, or operational metrics.
Experience providing education or consultation to operational teams regarding coding system functionality, workflow optimization, and regulatory changes.
Epic certification(s) related to HIM, Hospital Billing, Revenue Cycle, or Clinical applications.
Bachelor's or Master's degree in Health Information Management, Health Informatics, or Healthcare Administration.

Responsibilities

Supervises the development, enhancement, optimization, validation, and ongoing support of network coding applications and related health information technologies.
Independently manages large functional areas of the network coding application environment.
Applies advanced expertise in ICD-10-CM/PCS, CPT, HCPCS, and official coding and reimbursement guidelines to evaluate, configure, and optimize coding system functionality.
Facilitates strategic decisions and operational initiatives that impact coding compliance, reimbursement integrity, revenue cycle performance, quality reporting, and regulatory reporting.
Participates in the analysis, design, implementation, integration, and maintenance of network coding applications and their interfaces with the electronic health record and other clinical and financial systems.
Leads the development and oversight of system validation rules, automation, and coding edits to ensure compliant and accurate code assignment.
Collaborates with coding operations, clinical documentation integrity, information technology, vendors, and other network stakeholders to evaluate user feedback, identify system enhancement opportunities, and implement solutions.
Evaluates departmental and interdepartmental workflows to identify opportunities for sustainable process improvement.
Leverages expertise in coding regulations, reimbursement methodologies, and external reporting requirements to ensure workflow and system design decisions support accurate coding, reimbursement, regulatory reporting, and organizational performance.