Director of Coding & CDI

About the role

The Director of Coding and CDI will provide strategic leadership and operational oversight for system-wide documentation integrity and all inpatient and outpatient soft coding functions across acute and ambulatory settings. This role ensures clinical data accurately reflects patient complexity, supports appropriate reimbursement, and maintains strict compliance with federal, state, and payer regulations.

Responsibilities

• Strategic Leadership & Operations Performance Management: Define and monitor KPIs for inpatient, ambulatory surgery (ASC), and outpatient coding operations, including coding quality metrics and productivity benchmarks.

• Operational Oversight: Manage all medical coding activities (ICD-10-CM/PCS, CPT-4, HCPCS) and oversee third-party or offshore coding vendors for contract compliance.

• Leverage EHR (Oracle/Epic) and encoding platforms (Solventum/3M) to automate workflows and optimize DNFB management and charge capture.

• Policy Governance: Establish and maintain policies that uphold regulatory standards and safeguard data integrity within the EHR in alignment with AHIMA, ACDIS, and AAPC standards.

• Lead enterprise-wide CDI efforts, including concurrent/retrospective reviews to support accurate DRG assignment, HCC capture, and quality reporting (Vizient, USNWR).

• Drive the query management process inpatient and outpatient, tracking physician agreement rates and outcomes.

• Partner with Physician Advisors, Surgeons, and Hospitalists to deliver education on medical necessity and CMS Conditions of Participation.

• Focus efforts on moving inpatient accounts from Zero to One CC/MCC to accurately reflect patient severity prior to claim release.

• Collaboration & Denials Management Cross-Functional Partnership: Act as a bridge between clinical staff and management to align documentation with patient care goals.

• Collaborate with Revenue Integrity and PA advisors to reduce clinical denials and improve hospital quality scores through clinical validation.

Qualifications/Requirements

• Bachelor’s degree in healthcare administration, Nursing, or Business/Finance required.

• Master’s degree (MBA, MHA, or Organizational Leadership) preferred or in process.

• Coding, inpatient and outpatient certification and/or CDI certification required upon hire or transfer.

• Inpatient Coding: CCS (AHIMA), CIC (AAPC)

• Outpatient Coding: CCS-P (AHIMA), CPC, or COC (AAPC), CDI: CDIP (AHIMA) or CCDS (ACDIS), CDEO (AAPC), CDEI AAPC

• Minimum 15 years leadership/management experience and of varied experience in acute hospital and outpatient surgical services, professional billing etc.

• Excellent written and oral communication skills.

Benefits

Total Rewards at AtlantiCare offers a comprehensive suite of benefits and resources, including:

• Generous Paid Time Off (PTO)
• Medical, Prescription Drug, Dental & Vision Insurance
• Retirement Plans with employer contributions
• Short-Term & Long-Term Disability Coverage
• Life & Accidental Death & Dismemberment Insurance
• Tuition Reimbursement to support your educational goals
• Flexible Spending Accounts (FSAs) for healthcare and dependent care
• Wellness Programs to help you thrive
• Voluntary Benefits, including Pet Insurance and more

Pay

Pay transparency information is provided as required by law.

Schedule

Details on the schedule are not specified in the job posting.