Director, Professional Coding Services

• 1. Provide strategic leadership for professional coding, align operations with organizational goals and provide mentorship and professional development for staff and leaders.
• 2. Develops and implements policies, procedures, and quality assurance programs to ensure accurate coding and billing practices.
• 3. Serves as an expert leader for professional coding services. Provides insights for new coding rules and programs and ensures smooth and compliant implementations.
• 4. Defines and directs activities for short and long-term departmental strategic plans, programs, and objectives directed to improve the quality and scope of work performed to meet staff and operational needs.
• 5. Monitors and analyzes key performance metrics related to the revenue cycle, identifying opportunities for improvement and executing on changes necessary.
• 6. Monitors unbilled account dashboards on a daily basis for aging or un-coded services to reduce pre-accounts receivable days. Ensures coding compliance and AR targets are met.
• 7. Oversees daily operations including workload and staffing; hiring, disciplining and performance appraisals, ensures effective internal controls are in place, and monitors coding quality, education and training. This includes directing management/oversight of vendor support services.
• 8. Leads, manages and mentors team staff members to ensure a skilled workforce is in place for continual improvement of processes and procedures. Maintains an exceptional work environment through effective leadership, direction, supervision, role modeling, and communication. Schedules, plans, facilitates, and conducts staff meetings.
• 9. Directs activities of professional coding education, coordinates coding services that support the NEMG professional practices and leads collaboration efforts with System Compliance alignment.
• 10. Directs efforts related to technology enhancements for the professional coding services to optimize workflows, streamline services and enhance compliant revenue.
• 10.1 Develops bi-directional systems that create effective communication supporting revenue cycle optimizations.
• 11. Develops and maintains department budget.
• 12. Establishes a Coding Recruiting and Retention Strategy that ensures a coding staff that possesses a solid coding knowledge base by upskilling existing staff and recruiting new coders to meet ongoing demands for coding positions.
• 13. Oversees the development and maintenance of coding policies, procedures and guidelines. This includes the creation of a coding audit and education program.
• 14. Provides oversight and direction on all professional coding audit activities and education.
• 15. Within the division, conducts trend analysis to identify patterns and variations in coding practices and coding quality while ensuring appropriate documentation is met to mitigate coding denials and compliance risk. Monitors factors influencing coding compliance, reimbursement, and other metrics and implements practice changes as appropriate.
• 16. Works collaboratively with a wide variety of staff and management within the health system including NEMG operational leadership, Yale Medicine coding and billing, finance leadership, Revenue Integrity, NEMG professional billing team ambulatory case management and Population Health leadership to support the ongoing programs and new programs ensuring compliant practices. Also, ongoing collaboration with Yale Medicine coding to ensure compliant and accurate professional coding practices and capture.
• 16.1 Lead alignment strategies with YM professional coding.
• 17. Develops performance management oversight, employee engagement, and communication strategies and ensures ongoing communication with remote workforce.
• 18. Prepares administrative reports as requested and serves as expert resource for YNHHS in payment methodology.
• 19. Identifies opportunities for revenue improvements through accurate and compliant coding practices and denial reductions.
• 20. Diligently helps shape a positive, resilient, innovative and dedicated high-performance culture committed to excellence including succession planning and mentoring.

EDUCATION

Bachelor's degree in Health Information Management or other related healthcare field required. Master's degree preferred. Coding credential through AAPC or AHIMA required. RHIA or RHIT preferred.

EXPERIENCE

Eight to ten years of demonstrated progressive work experience in a leadership capacity in healthcare. Extensive knowledge and experience with professional and facility charges, ICD-10 and CPT coding principles and guidelines. Applicant must possess strong revenue cycle experience working closely with the Billing Office, Revenue Integrity and Clinical Documentation Improvement. Demonstrated accomplishments for revenue cycle and strategic initiatives.

SPECIAL SKILLS

Expert knowledge of ICD-10-CM, CPT and HCPC coding and payment methodology. Understanding of current billing and regulatory requirements, including federal compliance regulations and coding guidelines. Strong managerial, leadership and interpersonal skills. Must possess ability to work with revenue cycle enhancements. Excellent interpersonal and presentation skills. Well-developed communication skills, analytical skills, and use of Microsoft Office tools. Strong knowledge of systems. Ability to work with a diverse group of clinicians, ancillary departments, and office staff.