System Professional Coding Operations Director

• Responsible for all professional fee coding operations and staff, including outsourced vendors. Ensures appropriate quality and quantity of staffing supporting physician coding across RWJBH entities.
• Assesses and tracks productivity and quality of staff, creates and delivers education for correct and compliant coding practices, annual code updates, and compliant coding related to billing processes (NCCI edits, modifiers).
• Ensures the accuracy and integrity of ICD-10-CM and CPT procedure coding for accounts to maintain compliance with federal and state coding regulations.
• Oversees the timely and accurate submission of all professional fee coding data.
• Monitors, expedites, and follows up on the unbilled accounts to ensure release within bill hold timelines.
• Monitors professional fee coding charge review work queues, unbilled accounts, and account aging to ensure timely claims submission.
• Manages appropriate work queues, ensuring timely resolution of vendor coder inquiries.
• Monitors outsourced coders’ productivity and quality to ensure performance standards are met and aligned with revenue cycle goals.
• Oversees ongoing quality assurance in professional fee coding, abstracting, and data entry prior to billing. Analyzes trends and reports findings to coding leadership with recommended action plans.
• Conducts random and focused chart reviews of coding staff. Maintains documentation of results, recommends education, and delivers training as needed. Reviews include E/M levels, medical necessity, NCCI edits, and other critical coding areas.
• Analyzes billing data and collaborates with the Denials Team to address root causes at the coding and billing levels. Reviews the application of edits for compliance with guidelines and internal policies.
• Performs regular claim scrubs to identify and resolve potential or actual rejections and denials. Collaborates with the Denials Team to address deficiencies in code selection and entry.
• Collaborates effectively with clinicians, healthcare providers, Revenue Cycle teams, and Coding leadership.
• Acts as a liaison between the Coding team, front end operations, and other departments as necessary.
• Provides educational support to vendor professional fee coders. Develops and delivers targeted education and annual/quarterly updates. Requests corrective action plans based on trends identified through internal and external reviews.
• Creates and maintains standardized policies and procedures for coding staff, in collaboration with coding leadership and based on current guidelines. Updates policies at least annually.
• Monitors Local Coverage Determinations (LCDs), National Coverage Determinations (NCDs), payer articles, and guidelines. Maintains a centralized repository of references for organizational use.
• Manages outsourced coding operations and vendor relationships.
• Performs other duties as assigned.

• CPC or COC required, with a minimum of 8–10 years of coding experience. CPB and CPMA are strongly preferred.
• Bachelor’s Degree or equivalent experience required.
• Minimum of 3–5 years of experience in a managerial role.
• Must have extensive knowledge of CPT, HCPCS, and ICD-10-CM Official Coding Guidelines, with a comprehensive understanding of diagnosis and procedure coding systems.
• Must have in-depth knowledge of coding processes, workflow management, and electronic health record (EHR) systems.
• Must be proactive and able to work independently, managing multiple tasks and shifting priorities to meet deadlines.
• Must thrive in a fast-paced healthcare environment, perform well under pressure, and adapt effectively to constant change.
• Must possess strong organizational and planning abilities, along with excellent verbal, written, and interpersonal communication skills.
• Proficiency in Microsoft Office Suite (Excel, PowerPoint, Word) and coding software platforms (e.g., 3M, EncoderPro, Epic) is preferred.
• Must maintain active certification(s) and participate in continuing education as required by credentialing bodies.
• Some travel may be required for vendor oversight or on-site collaboration.

• Paid Time Off (PTO)
• Medical and Prescription Drug Insurance
• Dental and Vision Insurance
• Retirement Plans
• Short & Long Term Disability
• Life & Accidental Death Insurance
• Tuition Reimbursement
• Health Care/Dependent Care Flexible Spending Accounts
• Wellness Programs
• Voluntary Benefits (e.g., Pet Insurance)
• Discounts Through our Partners such as NJ Devils, NJ PAC, Verizon, and more!

RWJBarnabas Health