Note: The job is a remote job and is open to candidates in USA. Signature Performance, Inc. is dedicated to lowering healthcare administrative costs for federal government agencies, payers, and providers. The Director of Coding Operations will ensure coding practices support claims generation and optimal reimbursement while collaborating with various teams to enhance revenue cycle performance.
Responsibilities
- Maintain expert knowledge of healthcare revenue cycle operations and the impact of coding on reimbursement, revenue integrity, claims adjudication, and denial prevention
- Ensure accurate application of revenue codes, bill types, condition codes, occurrence codes, occurrence span codes, value codes, discharge dispositions, and other claim elements impacting reimbursement
- Partner with Revenue Integrity, Patient Financial Services, CDI, Case Management, and Client Operations teams to improve revenue cycle performance
- Analyze coding-related denials, edits, underpayments, and reimbursement variances and implement corrective action plans
- Support optimization of clean claim rates, DNFB reduction, charge capture effectiveness, and accounts receivable performance
- Monitor changes in Medicare, Medicaid, commercial payer, and managed care reimbursement methodologies
- Collaborate in the development of revenue cycle workflows that support accurate charge capture, coding, billing, and payment processes
- Serve 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
- Review claim denials and rejections pertaining to coding and medical necessity issues and, when necessary, implement processes, such as educational programs, or revamp current processes to prevent similar denials and rejections from recurring
- Guide performance from strategy through to frontline operations by giving the front-line information they need to know
- 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
Skills
- Associate's degree in Health Information Management or other healthcare-related field required
- 10 years' knowledge and experience in healthcare leadership required
- 10 years 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 Required: RHIA/RHIT and CCS/CPC
- 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
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
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