Note: The job is a remote job and is open to candidates in USA. SYSTEM West Virginia University Health System is hiring a Director to lead enterprise coding quality assurance, audit, education, compliance validation, and technology-enabled quality across Hospital Billing and Professional Billing. The role sets strategy and governance, directs teams and external coding partners, and oversees audit programs, remediation, education, reporting, and controls for emerging coding technologies.
Responsibilities
- Establishes and directs the enterprise strategy, governance framework, and operating model for coding quality assurance, audit, education, and validation across Hospital Billing and Professional Billing
- Provides executive oversight of routine, focused, compliance-directed, and risk-based coding audit programs to evaluate coding accuracy, documentation support, regulatory compliance, reimbursement integrity, and adherence to organizational standards
- Approves and maintains enterprise audit methodologies, sampling standards, scoring protocols, quality thresholds, escalation criteria, and remediation expectations to ensure consistent application across coding functions
- Analyzes enterprise coding quality trends, risk indicators, and performance results; identifies systemic or high-risk concerns and provides recommendations to senior Revenue Cycle, Coding, Compliance, and operational leadership
- Ensures corrective action, remediation, re-audit, and sustained-improvement processes are established and executed for significant coding quality or compliance findings
- Provides leadership and direction to assigned managers, Coding Auditor/Educator staff, and other quality resources, including performance expectations, coaching, succession planning, talent development, workload alignment, recruitment, and retention
- Develops and directs the enterprise coding education strategy based on audit findings, regulatory changes, payer requirements, operational priorities, technology changes, and identified competency needs
- Establishes standards for coding education, guidance, communication, onboarding, continuing education, and competency development across Hospital Billing and Professional Billing to promote enterprise consistency and alignment
- Defines measurable outcomes for education and remediation programs and ensures interventions are timely, evidence-based, and effective in improving coding performance and reducing recurring risk
- Establishes leadership expectations, competency standards, and career development pathways for coding quality, audit, and education roles; supports professional development and succession planning across the function
- Partners with Coding leadership to identify enterprise workforce development needs, emerging skill requirements, and opportunities to strengthen coder proficiency, specialization, and readiness for evolving coding technologies
- Directs the strategy and governance for external coding audits, independent reviews, specialty reviews, and other coding quality assessments; determines when external validation is appropriate based on risk and business need
- Establishes quality requirements, service expectations, audit methodologies, reporting standards, and performance measures for external coding partners and vendors
- Maintains executive accountability for quality validation of coding performed by external partners, including trend review, issue escalation, corrective action, and ongoing performance monitoring
- Serves as a senior partner to Compliance and Coding leadership on coding-related compliance reviews, regulatory changes, investigations, risk assessments, corrective action plans, and other high-priority coding matters
- Ensures centralized governance, documentation, and reporting of significant audit findings, education interventions, remediation activities, corrective actions, re-audits, risk status, and closure
- Develops and oversees enterprise quality monitoring and validation strategies for computer-assisted coding, AI-assisted coding, autonomous coding, and other emerging technologies that influence coding outcomes
- Partners with Epic/Information Technology, Compliance, Coding leadership, clinical and operational stakeholders, and technology vendors to evaluate automation accuracy, exceptions, overrides, workflow impact, controls, and emerging coding risks
- Establishes enterprise coding quality dashboards, key performance indicators, executive reporting, and benchmarking methodologies; communicates performance, trends, risks, and opportunities to senior leadership
- Develops annual and long-range priorities for the coding quality and education function, including resource planning, staffing models, vendor utilization, budget considerations, technology needs, and strategic initiatives aligned with Revenue Cycle and organizational goals
Skills
- Bachelor's degree in Health Information Management, Health Information Administration, Healthcare Administration, Business Administration, or related field AND five (5) years of progressive experience in medical coding, coding auditing, coding quality assurance, coding education, compliance, or a related revenue cycle function
- Associate's Degree in Health Information Technology AND seven (7) years of progressive experience in medical coding, coding auditing, coding quality assurance, coding education, compliance, or a related revenue cycle function
- High school diploma AND ten (10) years of progressive experience in medical coding, coding auditing, coding quality assurance, coding education, compliance, or a related revenue cycle function AND active coding certification from the American Health Information Management Association or American Academy of Professional Coders
- Three (3) years of leadership experience with responsibility for coding quality, auditing, education, compliance, or a related revenue cycle function
- Expert knowledge of ICD-10-CM, ICD-10-PCS, CPT, HCPCS, official coding guidelines, reimbursement methodologies, payer requirements, and applicable regulatory standards
- Advanced knowledge of coding quality assurance, audit methodology, healthcare reimbursement, compliance principles, documentation requirements, and revenue integrity practices
- Demonstrated ability to lead enterprise programs, establish governance, translate strategic priorities into operational plans, and drive measurable performance improvement
- Strong analytical and critical-thinking skills with the ability to interpret complex coding quality data, identify enterprise trends and risks, and develop actionable recommendations for senior leadership
- Demonstrated leadership ability, including team development, coaching, performance management, succession planning, change leadership, and management through other leaders
- Excellent written, verbal, presentation, and executive communication skills, including the ability to communicate complex coding, compliance, and quality issues to varied audiences
- Ability to build effective partnerships across Coding, Compliance, Revenue Cycle, Information Technology, Finance, clinical, operational, and vendor teams in a complex matrixed environment
- Demonstrated ability to evaluate coding technology, automation, vendor performance, and emerging industry practices while balancing quality, compliance, operational efficiency, and organizational risk
- Master's degree in Business Administration, Healthcare Administration, Health Information Management, or related field
- Active coding certification from the American Health Information Management Association or American Academy of Professional Coders
- Five (5) years of leadership experience in coding quality assurance, coding audit, compliance, or coding education within a large, complex healthcare system, including experience supporting both Hospital Billing and Professional Billing environments
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