The Program Director, Hospital Coding & Billing provides strategic and operational leadership for HURC's hospital coding and billing programs. This role serves as a senior subject matter expert and client-facing leader, evaluating revenue cycle operations, identifying performance opportunities, and implementing solutions that improve coding accuracy, reimbursement, compliance, quality, and financial outcomes. The Program Director partners with clients and internal teams across coding, clinical documentation, billing, denials, revenue integrity, and utilization management to develop scalable solutions and optimize hospital revenue cycle performance. Key Responsibilities Program Leadership - Provide strategic and operational leadership for hospital coding and billing programs. - Develop program strategies, workflows, performance standards, KPIs, and implementation plans. - Monitor performance, identify improvement opportunities, and implement corrective action plans. - Develop scalable processes and best practices across multiple clients. - Drive improvements in coding accuracy, reimbursement, productivity, quality, and financial performance. Hospital Coding & Billing Operations - Serve as a subject matter expert in inpatient and outpatient hospital coding and billing. - Evaluate workflows, identify operational gaps, and recommend process improvements. - Analyze coding accuracy, productivity, quality, reimbursement, and compliance trends. - Assess the impact of clinical documentation, coding, billing, and denials on financial performance. - Identify opportunities to reduce denials, prevent revenue leakage, and improve charge capture and claim submission. - Partner with CDI, coding, utilization review, denials, and revenue cycle teams to optimize outcomes. - Maintain current knowledge of ICD-10-CM/PCS, CPT, HCPCS, MS-DRGs, APCs, modifiers, NCCI edits, medical necessity, and payer requirements. Client Leadership - Serve as a trusted advisor and senior client-facing leader. - Lead operational assessments, client meetings, executive presentations, and performance reviews. - Translate complex revenue cycle challenges into clear, actionable recommendations. - Build relationships with hospital executives, HIM and coding leaders, revenue cycle executives, finance teams, physicians, and other stakeholders. - Manage client escalations and ensure timely resolution. - Identify opportunities to expand client relationships through additional HURC solutions. Revenue Cycle Optimization - Evaluate hospital revenue cycle operations to identify performance and reimbursement opportunities. - Analyze the impact of coding, CDI, billing, denials, utilization, and payer behavior on financial outcomes. - Support initiatives to improve clean claim rates, reduce denials, accelerate reimbursement, and prevent revenue leakage. - Establish performance benchmarks and improvement targets with clients. - Monitor financial and operational results following implementation. Analytics & Reporting - Analyze coding, billing, operational, and financial data to identify trends and opportunities. - Develop and interpret dashboards, KPIs, and performance reports. - Establish baselines and measurable improvement targets. - Evaluate productivity, quality, denial, reimbursement, and financial metrics. - Translate data into actionable recommendations for clients and executive leadership. - Partner with HURC analytics resources to develop client reporting. Implementation & Project Management - Lead implementation of coding, billing, and revenue cycle programs. - Develop project plans, timelines, milestones, and deliverables. - Coordinate cross-functional teams and manage implementation risks. - Ensure projects remain on schedule and achieve defined outcomes. - Communicate project status, risks, and recommendations to clients and executive leadership. Quality, Compliance & Audit - Ensure programs align with applicable federal and state regulations, payer requirements, and client policies. - Monitor coding quality and compliance. - Support internal and external audits. - Identify compliance risks and recommend corrective action. - Develop quality assurance and monitoring processes. - Maintain appropriate documentation and audit trails. Leadership & Team Development - Provide functional leadership and mentorship to coding, billing, and revenue cycle professionals. - Establish performance expectations and accountability. - Support coding and billing education and training initiatives. - Identify development needs and promote continuous improvement, quality, and client service. Qualifications Required - Bachelor's degree in Health Information Management, Healthcare Administration, Business, Finance, or a related field. Equivalent experience may be considered. - 7+ years of progressive experience in hospital coding, billing, HIM, revenue cycle, or healthcare financial operations. - 3+ years of leadership or program management experience. - Strong knowledge of inpatient and outpatient hospital coding, billing, and revenue cycle operations. - Experience working with healthcare clients, hospitals, health systems, or physician organizations. - Demonstrated experience analyzing operational and financial performance. - Experience leading process improvement or revenue cycle initiatives. - Strong understanding of payer requirements and reimbursement methodologies. - Excellent written, verbal, presentation, and executive communication skills. - Demonstrated ability to lead complex projects and cross-functional teams. Preferred - RHIA, RHIT, CCS, CPC, COC, or other relevant HIM/coding certification. - Experience with EPIC or other major EHR platforms. - Experience with encoder, CAC, CDI, billing, or revenue cycle technology. - Experience with Power BI or other healthcare analytics platforms. - Experience with hospital denials and appeals. - Experience in revenue integrity. - Experience working with outsourced coding or revenue cycle organizations. - Experience managing multi-client or national healthcare programs.

Program Director, Coding HB

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