Director of Coding Operations

Signature Performance, Inc.•,

12d•Remote

About The Position

In the role of Director of Coding Operations, you will be responsible for ensuring coding practices support claims generation, clean claim submission, optimal reimbursement, and appropriate revenue recognition. This position is primarily remote; however, travel up to monthly may be required for client site visits, operational reviews, leadership meetings, onboarding activities, business development support, and industry conferences.

Requirements

Associate's degree in Health Information Management or other healthcare-related field required
10 years' knowledge and experience in healthcare leadership required.
10 years knowledge and experience in coding, information privacy, laws, access, security, release of information and access control technology required.
Extensive knowledge of inpatient, outpatient, professional fee, and specialty coding operations, including ICD-10-CM/PCS, CPT, HCPCS, MS-DRGs, APR-DRGs, APCs, revenue codes, bill types, modifiers, condition codes, value codes, Medicare payment methodologies, and revenue cycle processes.
Demonstrated experience analyzing the downstream impact of coding decisions on claims processing, reimbursement, denials management, revenue integrity, and net revenue performance.
Strong understanding of hospital and physician revenue cycle workflows, including patient access, charge capture, coding, billing, claims management, denial prevention, payment posting, and accounts receivable management.
RHIA/RHIT and CCS/CPC certifications required.
U.S. Citizenship or naturalized citizenship is required for this position.
All work on all positions at Signature Performance must be completed in the continental United States, Alaska, or Hawaii.

Nice To Haves

Bachelor's degree preferred
Experience with Revenue Integrity programs.
Experience with Chargemaster (CDM) review and maintenance.
Experience with denial management and appeals processes.
Experience supporting Critical Access Hospitals, Rural Health Clinics, PPS hospitals, and physician practices.
Knowledge of Medicare OPPS, IPPS, CAH reimbursement, physician fee schedule methodologies, and value-based reimbursement models.

Responsibilities

Maintain expert knowledge of healthcare revenue cycle operations and the impact of coding on reimbursement, revenue integrity, claims adjudication, and denial prevention.
Ensure accurate application of revenue codes, bill types, condition codes, occurrence codes, occurrence span codes, value codes, discharge dispositions, and other claim elements impacting reimbursement.
Partner with Revenue Integrity, Patient Financial Services, CDI, Case Management, and Client Operations teams to improve revenue cycle performance.
Analyze coding-related denials, edits, underpayments, and reimbursement variances and implement corrective action plans.
Support optimization of clean claim rates, DNFB reduction, charge capture effectiveness, and accounts receivable performance.
Monitor changes in Medicare, Medicaid, commercial payer, and managed care reimbursement methodologies.
Collaborate in the development of revenue cycle workflows that support accurate charge capture, coding, billing, and payment processes.
Serve as a subject matter expert regarding the relationship between clinical documentation, coding, revenue codes, bill types, APCs, DRGs, HCPCS/CPT codes, and payer reimbursement methodologies.
Review claim denials and rejections pertaining to coding and medical necessity issues and, when necessary, implement processes, such as educational programs, or revamp current processes to prevent similar denials and rejections from recurring.
Guide performance from strategy through to frontline operations by giving the front-line information they need to know.