Director of Coding Operations

About the Role

We are seeking a Director of Coding Operations who enjoys translating coding operations into measurable revenue cycle outcomes. This role requires a strong understanding of how documentation, charge capture, coding, claims generation, reimbursement methodology, payer edits, and denial management collectively impact an organization's financial performance.

In this role, you will ensure coding practices support claims generation, clean claim submission, optimal reimbursement, and appropriate revenue recognition. Key responsibilities include:

• Maintaining expert knowledge of healthcare revenue cycle operations and the impact of coding on reimbursement, revenue integrity, claims adjudication, and denial prevention.
• Ensuring accurate application of revenue codes, bill types, condition codes, occurrence codes, occurrence span codes, value codes, discharge dispositions, and other claim elements impacting reimbursement.
• Partnering with Revenue Integrity, Patient Financial Services, CDI, Case Management, and Client Operations teams to improve revenue cycle performance.
• Analyzing coding-related denials, edits, underpayments, and reimbursement variances and implementing corrective action plans.
• Supporting optimization of clean claim rates, DNFB reduction, charge capture effectiveness, and accounts receivable performance.
• Monitoring changes in Medicare, Medicaid, commercial payer, and managed care reimbursement methodologies.
• Collaborating in the development of revenue cycle workflows that support accurate charge capture, coding, billing, and payment processes.
• Serving 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.
• Reviewing claim denials and rejections pertaining to coding and medical necessity issues and implementing processes, such as educational programs or revamping current processes, to prevent recurrence.
• Guiding performance from strategy through to frontline operations by providing front-line staff with necessary information.

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

• Education: Associate's degree in Health Information Management or other healthcare-related field required; Bachelor's degree preferred.
• Experience:
  • 10 years of knowledge and experience in healthcare leadership required.
  • 10 years of 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.
• Certifications: RHIA/RHIT and CCS/CPC required.

Preferred Qualifications

• 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.

About Us

We are looking for uncommon individuals to help us in our mission of lowering healthcare administrative costs for federal government agencies, payers, and providers. At Signature, our mission is to improve the health of our clients' business and make the lives of the people we work with better. We lead with our values of Passion, Courage, Integrity, and Respect in all interactions, making us a consistent annual Best Places to Work organization.

Benefits

• Health Insurance
• Fully Paid Life Insurance
• Fully Paid Short- & Long-Term Disability
• Paid Vacation
• Paid Sick Leave
• Paid Holidays
• Professional Development and Tuition Assistance Program
• 401(k) Program with Employer Match