Director Coding, CDI, Audit/Education

The Director of Coding/CDI/Education/Auditing is responsible for strategic oversight and operational leadership of coding, CDI, Auding/Education functions across an eight-hospital integrated health system and all Carle physician groups. Oversee all aspects of inpatient, outpatient and professional coding operations, clinical documentation, coding audit and education, chargemaster coding activities including coding denial management. Plans, organizes, and leads the Health Information Management coding team ensuring compliance with federal state and payer regulations and driving initiatives to improved coding quality and efficiency.

The Director will collaborate with key stakeholders including clinical departments, revenue cycle teams, quality, compliance and leadership to optimize the coding process and to support both clinical and financial objectives for the organization. Reviews and manages offshore vendor and coding contracts. Serves as a resource for HIM topics to revenue cycle, medical and administrative committees as needed. Has budget responsibilities.

Certifications:

• Registered Health Information Administrator (RHIA) or
• Registered Health Information Technician (RHIT)
  • Preferred: CCDS or CDIP

Education:

• Bachelor's Degree: Health Information Management or
• Bachelor's Degree: Health Information Administration

Work Experience:

• Health Information Management Director Level Leadership - 5 years and
• Health Information Management - 7 years
• Enterprise Acute Care

Knowledge and Skills:

• Strong leadership and management skills, with ability to motivate team.
• Proven management and organizational skills
• Knowledge of all major aspects of coding and audit and documentation integrity functions
• Knowledge of hospital (facility) and physician (professional) coding and billing processes.
• Thorough understanding of codes sets, including ICD10, DRG, HCPCS, CPT, E/M, RVUs, LCDs and NCDS.
• Proven experience managing teams across multiple hospitals or large integrated system.
• Demonstrated success in driving quality improvement and revenue integrity initiatives.

• Excellent written and verbal communication skills.
• Analytical and critical thinking skills
• Ability to identify process improvement opportunities and implement solutions.
• Ability to collaborate with all levels in the organization.
• Proficient in Microsoft Office products including but not limited to: Excel, Word, PowerPoint.
• Proficient with EPIC, 3M Solventum, CDI, and CAC tools.
• Analytical knowledge in Tableau and Vizient encouraged.

• Provide system wide leadership for facility and professional coding, CDI, and internal auditing programs.
• Leads the standardization and integration of process across hospitals to ensure consistency and efficiency.
• Oversee accurate and timely coding and CDI concurrent reviews, physician query processes and education
• Includes close monitoring of the offshore coding vendor(s) quality and performance.
• Collaborates with clinicians, business partners and senior leadership, revenue cycle, compliance and quality departments to prioritize data driven projects, and to provider quality information to support various initiatives.

• Subject matter expert and advisor to senior leadership regarding regulatory changes, best practices and operational performance.
• Knowledge and application of regulatory requirements and payer specific coding guidelines and federal, state and payor reimbursement methods.
• Diagnostic Related Groups (DRGs) and severity systems as well as universal coding practices and guidelines followed.
• Oversees the development, review and revision of department policies and procedures.
• Lead, mentor, manage a team of managers, supervisors, auditors, CDI Specialists, and coding professionals across all facilities.

• Monitor staff productivity and quality, ensuring high performing teams meet or exceed KPIs.
• Foster a culture of accountability, compliance and professional development.
• Accountable for preparation and monitoring of operating and capital budgets and achieving budgetary success on annual basis.
• Lead internal and external audits, including preparation, response and implementation of corrective actions.
• Oversee education and training of regulatory updates, coding guidelines (ICD-10 CM/PCS, CPT, HCPCS) and documentation standards.

• Identifies trends, risks and opportunities for improvement.
• Provides leadership and works closely with Executive Director and VP Of HIM
• Establish vision a strategic direction and goals
• Develops appropriate tactical plans to optimize coding accuracy, documentation quality and revenue cycle performance.
• Assures technical expertise of the staff through continuing education and career path development, recognition of skills and talents, and succession planning.

• Reviews and manages coding vendor contracts for HIM activities with Exec. Director and VP of HIM.
• Optimize technology platforms, e.g. EPIC,3M, to enhance workflows and automate coding/CDI processes.
• Drive innovation through autonomous coding and AI integration.
• Lead system implementation projects and enhancements with HIM Technology and Revenue Cycle Systems.
• Analyze data to identify trends in coding quality, denial rates, query outcomes, physician compliance and financial performance.

• Present regular reports to executive leadership, including recommendations for improvement.
• Monitors workload and production goals are being met.
• Attend meetings as requested or required as coding.
• CDI and auditing/training expert.
• Ensures training and education of teams and providers occur regularly and according to policy.
• Ensure team is accountable and follows department and organizational policies.

Find it here.

Discover the job, the career, the purpose you were meant for. The supportive and inclusive team where you can thrive. The place where growth meets balance - and opportunities meet flexibility. Find it all at Carle Health.

Based in Urbana, IL, Carle Health is a healthcare system with nearly 16,600 team members in its eight hospitals, physician groups and a variety of healthcare businesses. Carle BroMenn Medical Center, Carle Foundation Hospital, Carle Health Methodist Hospital, Carle Health Proctor Hospital, Carle Health Pekin Hospital, and Carle Hoopeston Regional Health Center hold Magnet designations, the nation's highest honor for nursing care. The system includes Methodist College and Carle Illinois College of Medicine, the world's first engineering-based medical school, and Health Alliance. We offer opportunities in several communities throughout central Illinois with potential for growth and life-long careers at Carle Health.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. | For more information: human.resources@carle.com.