The Program Director, Hospital Coding & Billing is responsible for the strategic and operational leadership of hospital coding and billing programs supporting HURC clients.
This role serves as a senior subject matter expert and client-facing leader responsible for evaluating hospital revenue cycle operations, identifying performance opportunities, developing recommendations, and leading implementation initiatives that improve coding accuracy, billing performance, reimbursement, compliance, quality, and financial outcomes.
The Program Director will work across inpatient and outpatient coding, hospital billing, clinical documentation, denials, revenue integrity, utilization management, and other revenue cycle functions to identify opportunities and develop scalable solutions for healthcare clients.
This position requires a strong understanding of hospital revenue cycle operations, coding methodologies, payer requirements, reimbursement, analytics, and operational performance.
Key Responsibilities
- Program Leadership
- Provide strategic and operational leadership for hospital coding and billing programs.
- Develop program strategies, operating models, workflows, performance standards, and implementation plans.
- Establish program KPIs, targets, and performance expectations.
- Monitor program performance and develop corrective action and improvement plans.
- Identify opportunities to improve coding accuracy, reimbursement, productivity, quality, and financial performance.
- Develop scalable processes and best practices that can be applied across multiple clients.
- Hospital Coding & Billing Operations
- Provide subject matter expertise in hospital inpatient and outpatient coding and billing.
- Evaluate coding and billing workflows and identify operational gaps.
- Review coding accuracy, productivity, quality, reimbursement, and compliance trends.
- Evaluate the relationship between documentation, coding, billing, reimbursement, and denials.
- Identify opportunities to reduce coding-related denials and prevent revenue leakage.
- Evaluate charge capture, claim submission, edits, billing workflows, and payer requirements.
- Partner with CDI, coding, utilization review, denials, and revenue cycle teams to improve overall financial performance.
- Maintain knowledge of ICD-10-CM/PCS, CPT, HCPCS, MS-DRGs, APCs, modifiers, NCCI edits, medical necessity, and applicable payer requirements.
Client Leadership
- Serve as a senior client-facing leader and trusted advisor.
- Lead operational assessments, client meetings, executive presentations, and performance reviews.
- Develop recommendations based on client data, workflows, financial performance, and operational findings.
- Translate complex coding and revenue cycle issues into clear business recommendations.
- Establish strong relationships with hospital executives, HIM leaders, coding leaders, revenue cycle executives, finance leaders, physicians, and other stakeholders.
- Manage client escalations and ensure timely resolution.
- Identify opportunities to expand existing client relationships through additional solutions.
- Revenue Cycle Optimization
- Analyze the complete hospital revenue cycle to identify opportunities for improvement.
- Evaluate the impact of coding, CDI, billing, denials, utilization, and payer behavior on reimbursement.
- Identify revenue leakage and opportunities for improved reimbursement.
- Support initiatives designed to improve clean claim rates, reduce denials, accelerate reimbursement, and improve net revenue.
- Partner with clients to establish appropriate benchmarks and improvement targets.
- Monitor financial and operational outcomes following implementation.
Analytics & Reporting
- Review operational, coding, billing, and financial data to identify trends and opportunities.
- Develop and interpret dashboards and performance reports.
- Establish program baselines and measurable improvement targets.
- Analyze productivity, quality, denial, reimbursement, and financial metrics.
- Translate data into actionable recommendations for clients and executive leadership.
- Partner with HURC analytics resources to develop meaningful client reporting.
- Implementation & Project Management
- Lead implementation of new coding, billing, and revenue cycle programs.
- Develop project plans, timelines, milestones, and deliverables.
- Coordinate cross-functional teams throughout implementation.
- Identify implementation risks and develop mitigation strategies.
- Ensure projects remain on schedule and achieve defined outcomes.
- Communicate project status, risks, and recommendations to executive leadership and clients.
Quality, Compliance & Audit
- Ensure coding and billing programs comply 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.
- Ensure appropriate documentation and audit trails are maintained.
- Leadership & Team Development
- Provide functional leadership and mentorship to coding, billing, and revenue cycle professionals.
- Establish clear performance expectations and accountability.
- Support development of coding and billing education programs.
- Identify training needs and develop educational strategies.
- Promote a culture of quality, accountability, continuous improvement, and client service.
- Qualifications
Required
- Bachelor's degree in Health Information Management, Healthcare Administration, Business, Finance, or 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 hospital inpatient and outpatient coding knowledge.
- Strong understanding of hospital 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 with revenue integrity.
- Experience working with outsourced coding or revenue cycle organizations.
- Experience managing multi-client or national healthcare programs.
