System Professional Coding Operations Director

Job Title: Director

Location: System Business Office

Department Name: HIM - Professional

Req #: 48007

Status: Salaried

Shift: Day

Pay Range: $133,924- $207,582

Pay Transparency:

The above reflects the anticipated hourly wage range for this position if hired to work in New Jersey.

The compensation offered to the candidate selected for the position will depend on several factors, including the candidate's educational background, skills and professional experience.

Professional Coding Administrative & Data Support Specialist

Job Overview:

The System Professional Coding Operations Director is responsible for the day-to-day operations of the professional fee coding vendor across all RWJBH medical centers. This includes oversight of workflow, work queue management, and coordination with internal and external stakeholders to ensure timely, accurate, and compliant coding practices. Critical to this role is tracking of outsourced coding productivity and quality, creation and monitoring of performance dashboards, regular audits, and education creation and delivery to ensure accountability and contract compliance. Ongoing training for staff is directed at maintaining compliance and quality.

Essential Functions:

• 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.

Job Requirements:

• 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.

Other Duties:

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Benefits and Perks:

At RWJBarnabas Health, our market-competitive Total Rewards package provides comprehensive benefits and resources to support our employees' physical, emotional, social, and financial health.

• 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!

Choosing RWJBarnabas Health!

RWJBarnabas Health is the premier health care destination providing patient-centered,

high-quality academic medicine in a compassionate and equitable manner, while delivering

a best-in-class work experience to every member of the team. We honor and appreciate the privilege of creating and sustaining healthier communities, one person and one community at a time. As the leading academic health system in New Jersey, we advance innovative strategies in high-quality patient care, education, and research to address both the clinical and social determinants of health.

RWJBarnabas Health aims to truly make a unique impact in local communities throughout New Jersey. From vastly improving the health of local residents to creating educational and career opportunities, this combination greatly benefits the state. We understand the growing and evolving needs of residents in New Jersey-whether that be enhancing the coordination for treating complex health conditions or improving community health through local programs and education.

Equal Opportunity Employer