Regional Coding & Audit Director

$135,000 - $135,000/Yr

Execusource - Newnan, GA

Full-time - Senior

Remote - Newnan, GA

Administrative and Support Services

About the position

The Regional Coding & Audit Director will play a crucial role in the Revenue Cycle Leadership team of a large Urgent Care provider. This fully remote position focuses on developing and executing strategies for coding, audits, and provider education, ensuring compliance with regulatory standards and operational excellence. The director will lead coding and audit teams, manage key performance indicators, and drive initiatives that enhance quality and efficiency in healthcare delivery.

Responsibilities

• Formulate, direct, implement, administer, supervise, and plan enterprise-wide performance measurement-based strategies focused on quality/compliant practices and efficiency/automation.
• Lead the provider educator team (and vendors) to manage quality measures education and metrics improvement.
• Develop and share provider education opportunities with internal teams.
• Create compliance policies and review patient records in accordance with compliance policies and coding guidelines.
• Develop workflows to perform quality assurance (QA) auditing.
• Organize, lead, and participate in coding reviews/audits of medical records.
• Responsible for planning, scheduling, and conducting coding audits; and maintaining records of provider or vendor audit results.
• Document and present audit findings to the Code Council Committee, vendors, and other internal departments in an organized and actionable format.
• Educate and train peers and providers on a one-to-one or group basis to ensure accurate documentation and improve quality of care.
• Collaborate with other areas/departments of the company, external vendors, and medical groups to improve or maintain healthcare quality and risk adjustment metrics and programs.
• Work closely with the quality team to develop year-round provider education campaign strategy and parameters.
• Improve core process efficiency, effectiveness, and responsiveness; measure and improve business critical operational KPIs/metrics.
• Maintain up-to-date knowledge and coding credentials, current updates to governmental requirements and plan requirements related to proper coding through continued education, research and reading resource material.

Requirements

• Bachelor's degree in Healthcare Administration, Finance, Business, or related field; Master's degree preferred.
• Required Certified Professional Coder (CPC-I) certification, Certified Risk Adjustment (CRC) coder AAPC certification, and Certified Professional Medical Auditor (CPMA) certifications from AAPC (to obtain CPMA within 120 days from date of hire, if applicant does not currently possess).
• 6+ years of risk adjustment experience.
• 3+ years of provider education experience with the development of educational materials and presentations.
• 5+ years of physician billing/coding experience.
• Previous managerial experience.
• Exceptional relationship-building skills with clinical and non-clinical personnel.
• In-depth understanding of HIPAA.
• Familiarity with claims and encounter data processes.
• Related Bachelor's degree and RN licensure preferred.
• Strong leadership, communication, prioritizing, and interpersonal skills.
• Ability to develop, implement, and evaluate methods and systems to improve efficiency.
• Expertise in leading cross-functional workgroups.
• Strong understanding of accounting principles, revenue recognition, and financial processes.
• Advanced proficiency in Microsoft Office.
• Strong understanding of healthcare billing, coding, reimbursement principles, and industry regulations.
• High degree of organization with strict adherence to deadlines and a sense of urgency.
• Ability to manage high-stress situations and ensure healthy relationships with clients.
• Capability to comfortably handle issues and problem accounts.

Nice-to-haves

• Energy, enthusiasm, and the ability to work under pressure in a high volume, fast paced, unstructured start-up environment.
• Ability to work within a team environment and maintain a positive attitude.
• Excellent documentation, verbal, and written communication skills.
• Extremely organized with a strong attention to detail.
• Motivated, dependable, and flexible with the ability to handle periods of stress and pressure.

Benefits

• Fully remote work opportunity.
• Competitive salary range of $105-$135k.