Position Summary:The Senior Director – Coding Operations is responsible for management and delivery fulfillment for
MedReview’s team of certified coders and support staff. We are seeking either a certified coder or
registered nurse with extensive experience in both inpatient coding and clinical validation. The Sr.
Director oversees a team of in-house, offshore and vendor coders totaling 75+ employees. This
position is responsible for ensuring client and internal deliverables are achieved through active
management of production quotas, process optimization, quality assurance, onboarding/training,
staffing, and inventory management. The ideal candidate for this role is an experienced payment
integrity coding leader who has successfully managed people and processes in a high growth, fast
paced environment. A successful candidate has experience identifying and implementing process
optimization changes while concurrently meeting operational goals. This position is an operational
leader, and a focus on production, quality, staff time management and data driven decision-making is
critical.
Candidates must be highly motivated and possess a strong clinical and coding background. This
individual must have excellent communication skills and an analytical mindset to achieve and maintain
high-level performance in a fast-paced environment.
This is a fulltime position (40 hours per week) Monday – Friday. You’ll enjoy the flexibility to
telecommute from anywhere within the United States.
Responsibilities:- Develops and directs strategic growth and operational objectives including productivity and quality standards. Integrates services and strategic plans with the mission, vision, and values of MedReview.
- Demonstrates the ability to think both critically and independently when encountering complex claim scenarios.
- Uses decisive judgement and the ability to work with minimal supervision. Must be able to work in a fast-paced environment and take appropriate action when needed.
- Develop and empower management team to lead daily operations, resolve issues, manage employee performance, manage physician relations, and ensure operational efficiencies.
- Establish and enforce coding performance metrics, monitor team performance, and implement strategies for continuous improvement.
- Serve as an expert resource for coding-related queries and provide expertise regarding complex coding claim scenarios.
- Prepare and present regular reports on coding accuracy, compliance, and productivity to executive leadership.
- Navigate the MedReview proprietary system daily to trouble shoot escalated claim issues.
- Monitor coding claim volume daily within the MedReview proprietary claims management system and ensure claims are being addressed in a timely manner.
- Oversee the daily operations of the coding department including workload, staffing, hiring, disciplining, performance appraisals, training, and monitoring of work.
- Coordinate the planning and development of all policies and procedures pertaining to the programs to ensure compliance to all local, state, and federal regulations and to meet the goals of the program.
- Interface with other internal departments as needed to ensure the smooth operation of all activities, such as MIS, account management, IT, etc.
- Participate in presentations for prospective new clients.
- Assists with the implementation of new clients.
- Oversee and ensure timely completion of reviews to ensure contract compliance and regulatory time frames are being met.
Qualifications:- Minimum of 10 years’ experience in inpatient coding and clinical validation in a payment integrity setting including both coding and clinical validation.
- Certified Inpatient Coder or unrestricted registered nurse with CCS (Certified Coding Specialist) or
- CIC (Certified Inpatient Coder).
- Bachelor’s degree preferred.
- Experience with ICD-10 coding.
- Direct experience managing DRG coding teams within a large fast-growing payment integrity vendor is highly desirable.
- Effective leadership skills.
- Excellent writing and communication skills.
- Excellent analytical skills
- Must have knowledge of and the ability to identify ICD-10 CM/PCS code assignment, code sequencing, and discharge disposition, in accordance with CMS requirements, Official Guidelines for coding and reporting, and Coding Clinic guidance.
- Must be fluent in application of current Official Guidelines and Coding Clinic Citations, in addition to demonstrating working knowledge of clinical criteria documentation requirements used to successfully substantiate code assignments.