The Director of Coding Integrity and Coding Edits provides strategic leadership and operational oversight for coding integrity programs, coding edit governance, and coding quality initiatives across the organization. This role ensures accurate, compliant, and optimized coding practices to support appropriate reimbursement, regulatory compliance, and overall revenue cycle performance.

The Director partners closely with the Director of Revenue Integrity and the Director of Hospital Billing (HB) Coding to align coding practices with charge capture, claim edits, payer requirements, and revenue cycle optimization. The position works collaboratively across HIM, revenue cycle, compliance, and clinical teams to ensure coding integrity and operational efficiency.

Coding Integrity Strategy
•    Develop and lead the organization's coding integrity program to promote accurate and compliant clinical coding.
•    Establish policies, procedures, and governance related to coding integrity and coding edits.
•    Ensure adherence to coding guidelines including:
o    ICD-10-CM
o    ICD-10-PCS
o    CPT
o    HCPCS
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Coding Edit Management
•    Oversee development, maintenance, and optimization of coding-related system edits.
•    Manage edit governance for coding validation, claim edits, and coding quality rules.
•    Work with IT and revenue cycle teams to ensure proper configuration of coding edits in billing and coding systems.
•    Evaluate edit performance to reduce claim rework and improve first-pass claim acceptance.
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Cross-Functional Revenue Cycle Collaboration
Partner closely with:
Director of Revenue Integrity
•    Align coding practices with charge capture and charge master governance.
•    Ensure coding accuracy supports appropriate reimbursement.
•    Identify revenue leakage or missed revenue opportunities related to coding.
Director of Hospital Billing Coding
•    Standardize inpatient and outpatient coding practices.
•    Improve coding quality and consistency across coding teams.
•    Address coding-related claim edits and billing issues.
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Coding Quality and Compliance
•    Develop and oversee coding audit and monitoring programs.
•    Identify trends and implement corrective action plans to improve coding accuracy.
•    Ensure compliance with regulatory and industry guidance from organizations including:
o    Centers for Medicare & Medicaid Services
o    American Hospital Association
o    American Medical Association
•    Support internal and external audits related to coding compliance.
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Coding Education and Continuous Improvement
•    Collaborate with coding education teams to ensure coders remain current with coding guideline changes.
•    Identify areas requiring targeted education or process improvement.
•    Support implementation of annual coding updates and regulatory changes.
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Data Analytics and Reporting
•    Monitor key performance indicators related to coding accuracy, edit performance, and denial trends.
•    Utilize analytics to identify coding opportunities, trends, and operational improvements.
•    Provide reporting and recommendations to the Senior Director of Coding and revenue cycle leadership.
 

• Bachelor’s degree in Health Information Management, Healthcare Administration, or related field preferred
• 8–10+ years of experience in hospital coding, coding compliance, or revenue cycle operations.
• 5+ years in leadership or management roles.
• Experience managing coding integrity initiatives, coding edits, and coding compliance programs.
• Strong experience collaborating with revenue cycle, compliance, and HIM leadership.
• Active professional coding credential(s) Active professional coding credential(s) (e.g., RHIA, RHIT, CCS, CCS-P).

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