Associate Director of Billing & Coding

Responsibilities

• Directly oversee professional coding operations.
• Ensure accurate CPT, HCPCS, and ICD-10 coding in accordance with payer and regulatory guidelines.
• Maintain coding productivity and quality on a daily and weekly basis.
• Conduct routine internal audits and address coding variances promptly.
• Lead corrective action plans when audit results fall below target thresholds.
• Stay current with CMS, payer, and specialty-specific coding updates.
• Oversee timely and accurate charge entry for all clinical services.
• Monitor lag days from date of service to claim submission.
• Identify and resolve missing charges, interface errors, and documentation gaps.
• Implement controls to reduce unbilled inventory and prevent revenue leakage.
• Validate modifiers and ensure compliance with payer-specific billing rules.
• Review work queues and charge edit reports daily.
• Intervene directly in complex or high-risk coding scenarios.
• Participate in denial root cause reviews related to coding or charge capture.
• Collaborate with AR leadership to address downcoding, bundling, and medical necessity denials.
• Monitor and reduce coding-related denial rates.
• Conduct detailed vendor performance reviews, including QC results and productivity tracking.
• Escalate deficiencies and require documented remediation plans.
• Participate directly in operational calls to review aging, denials, and backlog.
• Evaluate cost effectiveness and recommend insourcing when appropriate.
• Directly manage coding supervisors, leads, and charge entry staff.
• Set clear productivity and accuracy expectations.
• Conduct performance reviews and coaching sessions.
• Provide ongoing education and specialty-specific training.
• Develop high-performing coders with expertise in complex surgical and procedural coding (if applicable).
• Partner with physicians and practice leadership to improve documentation quality.
• Work closely with Revenue Cycle leadership to improve clean claim rates.
• Collaborate with IT on system edits, charge interfaces, and automation.
• Support new service lines and acquisitions with coding setup and charge master validation.
• Track and report on key performance indicators: Coding accuracy rate, Productivity benchmarks, Charge lag days, Coding-related denial rate, Unbilled inventory.
• Provide monthly reporting and operational improvement plans to RCM leadership.

Qualifications

• Bachelor’s degree or equivalent work experience.
• CPC, CCS-P, or equivalent professional coding certification required.
• 5–8+ years of progressive coding experience, including leadership.
• Experience in orthopedic, multi-specialty physician practices or large healthcare organizations.
• Strong knowledge of payer reimbursement methodologies.
• Experience managing high-volume professional coding environments.
• Proficiency in EHR and practice management systems.
• Strong technical coding expertise.
• Operational discipline and workflow management.
• Detail orientation.
• Regulatory compliance.
• Team leadership and accountability.
• Data-driven decision making.
• Problem-solving and escalation management.