We are seeking an experienced hospital billing coding leader to serve as Director, Hospital Billing Coding. Reporting to the Senior Director, Coding, this role is accountable for domestic day-to-day management of hospital and facility coding operations across assigned clients, facilities, patient types, and service areas. The Director owns inventory oversight, work-queue health, staffing and capacity direction, coder-performance monitoring, productivity, coding turnaround time, Pre-AR and SLA delivery, and service-line escalation management.

The Director leads onshore Hospital Billing Coding Leads and partners with global delivery leadership to coordinate coding execution across domestic and offshore teams while retaining Healthrise accountability for operational outcomes. The role provides direct liaison support to client stakeholders, translates facility, patient-type, payer, CDI, charging, and regulatory requirements into executable workflows, resolves material production risks, and ensures accurate, compliant assignment of ICD-10-CM/PCS, MS-DRG/APR-DRG, APC, HCPCS, revenue codes, modifiers, and POA indicators.

This leader collaborates closely with Coding Quality and Coding Education & Workforce Development: Quality retains independent audit methodology and scoring; Education owns learning strategy, content, competency, remediation programs, and workflow adoption; and Hospital Billing Operations retains accountability for production, staffing, inventory, work queues, Pre-AR, and SLA performance.

Duties and Responsibilities:

Hospital Billing Coding Operations Leadership

• Knows, understands, incorporates, and demonstrates the Healthrise Core Values in all interactions with team members, clients, and stakeholders.

• Provide domestic day-to-day management of hospital and facility coding operations across assigned clients, facilities, patient types, and service areas.

• Own daily account inventory oversight, work-queue prioritization and distribution, backlog prevention and recovery, hold/suspense management, and timely-filing protection.

• Monitor throughput, productivity-to-standard, work-queue aging, coding TAT, Pre-AR, edits, rework, and SLA performance by facility and patient type; investigate unfavorable variance and drive corrective action.

• Direct hospital coding execution for inpatient, outpatient surgery, emergency, observation, ancillary, and series accounts in accordance with approved SOPs, official guidance, grouper logic, NCCI edits, medical-necessity rules, and facility-specific requirements.

• Lead daily production huddles and weekly backlog, aging, productivity, staffing, coverage, and escalation reviews; ensure actions have clear owners, due dates, and closure evidence.

• Forecast demand and coordinate capacity, patient-type coverage, surge support, and phased ramp plans with the Senior Director and global delivery leadership.

• Own coding-side root-cause analysis and corrective action for productivity, backlog, TAT, Pre-AR, work-queue, documentation, access, workflow, and system issues; escalate upstream or client-owned barriers promptly.

People, Global Partner, and Client Leadership

• Lead, develop, and manage onshore Hospital Billing Coding Leads; establish clear operating expectations, service-area ownership, performance goals, and development priorities.

• Partner with global delivery leadership to align assignments, staffing, facility and patient-type coverage, productivity expectations, issue resolution, and evidence of corrective action without assuming direct people-management responsibility for offshore staff.

• Serve as the primary Hospital Billing Coding liaison to client stakeholders for operational performance, queue health, service delivery, implementation readiness, and escalations.

• Coordinate onboarding and offboarding, access requests, facility and patient-type assignments, production readiness, and go-live support with client, global partner, Quality, Education, CDI, and Revenue Integrity stakeholders.

• Promptly escalate notable productivity, operational, compliance, quality, or SLA risks to the Senior Director, Coding and appropriate global and client leadership.

Quality, Denials, Compliance, and Performance Governance

• Ensure hospital coding operations adhere to ICD-10-CM/PCS, CPT, HCPCS, POA, MS-DRG/APR-DRG, APC, NCCI, charging, clinical-validation, client, payer, HIPAA, and compliance requirements.

• Partner with the Director, Coding Quality on independent audits, calibration, coding-attributed denial and DRG-validation trends, error validation, and corrective actions while preserving Quality’s ownership of audit methodology, scoring, findings, and re-audit.

• Own the operational response to hospital coding edits and denials, including DRG, diagnosis, procedure, modifier, medical necessity, charge, and clinical-validation workflows; ensure rebills and coding rationale are complete and defensible.

• Engage the Director, Coding Education & Workforce Development when knowledge, competency, documentation, or workflow-adoption gaps require retraining, remediation, assessment, or content updates.

• Produce and present daily, weekly, and monthly dashboards by facility and patient type, including volume, productivity, backlog, aging, TAT, Pre-AR, SLA performance, edits, quality trends, risks, and corrective actions.

• Present performance, root-cause analysis, capacity outlook, risks, and improvement plans in monthly performance reviews, governance forums, and quarterly business reviews.

Cross-Functional Partnership and Client Delivery

• Partner with client operational leaders, Revenue Integrity, Compliance, CDI, IT, charging, billing, and payer-facing teams to resolve facility coding workflow, clinical-validation, and documentation issues.

• Provide operational subject-matter expertise for hospital billing work-queue design, routing, prioritization, reporting, automation, grouper and billing-edit changes; client teams retain system-build ownership.

• Co-design controlled process rollouts with Coding Education & Workforce Development, including scope, audience, timing, production readiness, go-live criteria, hypercare, and sustained-adoption measures.

• Identify, propose, pilot, and quantify hospital coding process improvements; support adoption of CAC, NLP, automation, analytics, and other productivity and quality tools.

• Support expansion to new clients, facilities, patient types, and service lines by validating scope, staffing, workflows, SOP inputs, competency requirements, readiness criteria, and ramp-to-SLA plans.

• Maintain project documentation, issue and escalation logs, decisions, mitigation plans, and closure evidence.

• Travel to client or organizational sites as required and perform other duties as assigned.

Required:

• Active hospital/facility coding credential required, such as CCS, RHIA, RHIT, CIC, or COC (AHIMA or AAPC), or equivalent.

• Minimum 7 years of progressive hospital or facility coding experience, including at least 3 years in coding operations leadership.

• Demonstrated expertise in ICD-10-CM/PCS, CPT, HCPCS, POA, MS-DRG/APR-DRG, APC, NCCI edits, medical necessity, clinical validation, revenue codes, modifiers, and facility coding workflows.

• Experience leading multi-facility hospital coding operations across inpatient, outpatient surgery, emergency, observation, ancillary, or related patient types, including work-queue management, capacity planning, backlog recovery, and SLA/TAT delivery.

• Demonstrated experience directly leading onshore teams and collaborating with global delivery or third-party partners on performance, remediation, escalation, and SLA accountability.

• Experience with hospital coding edits, denials, provider queries, CDI collaboration, charge review/correction, rebill workflows, root-cause analysis, and corrective action.

• Ability to analyze operational data and translate findings into actionable staffing, workflow, training, quality, and performance recommendations.

• Strong project management, client relationship, written communication, and executive presentation skills.

• Completion of regulatory and mandatory certifications as required.

• Willingness and ability to travel to client or organizational sites as needed, including minimum quarterly travel.

Preferred:

• Bachelor’s or master’s degree in health information management, healthcare administration, business, or a related field.

• Additional audit, CDI, compliance, or revenue-cycle credential such as CDIP, CCDS, CPMA, CPCO, CRCR, or FHFMA.

• Experience with Epic Hospital Billing/Resolute work queues, reporting, charge review, coding and billing edits, and related workflow tools.

• Experience supporting inpatient, outpatient surgery, emergency, observation, ancillary, series-account, DRG-validation, or other complex facility coding services.

• Lean Six Sigma certification or demonstrated experience facilitating structured process-improvement and root-cause workshops.

• Experience with CAC, NLP, AI-assisted coding, analytics, automation, or other technology used to improve hospital coding productivity and quality.