Director, Coding Quality Assurance and Education

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The Director of Coding Quality Assurance and Education provides strategic leadership and enterprise oversight for coding quality assurance, audit, education, compliance validation, and technology-enabled coding quality across Hospital Billing (HB) and Professional Billing (PB). This position establishes the enterprise vision, governance structure, standards, and performance expectations necessary to promote coding accuracy, regulatory compliance, consistency, operational excellence, and continuous improvement throughout WVU Medicine.

The Director leads the coding quality and education function, including assigned managers, Coding Auditor/Educator staff, and other quality resources, and serves as a senior partner to Coding leadership, Compliance, Clinical Revenue Cycle, Epic/Information Technology, Finance, operational leaders, and external coding partners. The Director is accountable for enterprise audit strategy, education and remediation programs, vendor quality assurance, executive-level reporting, and the development of controls for computer-assisted, AI-assisted, autonomous, and other emerging coding technologies.

MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:
1. Bachelor's degree in Health Information Management, Health Information Administration, Healthcare Administration, Business Administration, or related field AND five (5) years of progressive experience in medical coding, coding auditing, coding quality assurance, coding education, compliance, or a related revenue cycle function

OR

Associate’s Degree in Health Information Technology AND seven (7) years of progressive experience in medical coding, coding auditing, coding quality assurance, coding education, compliance, or a related revenue cycle function

OR

High school diploma AND ten (10) years of progressive experience in medical coding, coding auditing, coding quality assurance, coding education, compliance, or a related revenue cycle function AND active coding certification from the American Health Information Management Association or American Academy of Professional Coders.

EXPERIENCE:
1. Three (3) years of leadership experience with responsibility for coding quality, auditing, education, compliance, or a related revenue cycle function.

PREFERRED QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:
1. Master’s degree in Business Administration, Healthcare Administration, Health Information Management, or related field.

2. Active coding certification from the American Health Information Management Association or American Academy of Professional Coders.
EXPERIENCE:
1. Five (5) years of leadership experience in coding quality assurance, coding audit, compliance, or coding education within a large, complex healthcare system, including experience supporting both Hospital Billing and Professional Billing environments.

 

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an exhaustive list of all responsibilities and duties. Other duties may be assigned.

1. Establishes and directs the enterprise strategy, governance framework, and operating model for coding quality assurance, audit, education, and validation across Hospital Billing and Professional Billing.

2. Provides executive oversight of routine, focused, compliance-directed, and risk-based coding audit programs to evaluate coding accuracy, documentation support, regulatory compliance, reimbursement integrity, and adherence to organizational standards.

3. Approves and maintains enterprise audit methodologies, sampling standards, scoring protocols, quality thresholds, escalation criteria, and remediation expectations to ensure consistent application across coding functions.

4. Analyzes enterprise coding quality trends, risk indicators, and performance results; identifies systemic or high-risk concerns and provides recommendations to senior Revenue Cycle, Coding, Compliance, and operational leadership.

5. Ensures corrective action, remediation, re-audit, and sustained-improvement processes are established and executed for significant coding quality or compliance findings.

6. Provides leadership and direction to assigned managers, Coding Auditor/Educator staff, and other quality resources, including performance expectations, coaching, succession planning, talent development, workload alignment, recruitment, and retention.

7. Develops and directs the enterprise coding education strategy based on audit findings, regulatory changes, payer requirements, operational priorities, technology changes, and identified competency needs.

8. Establishes standards for coding education, guidance, communication, onboarding, continuing education, and competency development across Hospital Billing and Professional Billing to promote enterprise consistency and alignment.

9. Defines measurable outcomes for education and remediation programs and ensures interventions are timely, evidence-based, and effective in improving coding performance and reducing recurring risk.

10. Establishes leadership expectations, competency standards, and career development pathways for coding quality, audit, and education roles; supports professional development and succession planning across the function.

11. Partners with Coding leadership to identify enterprise workforce development needs, emerging skill requirements, and opportunities to strengthen coder proficiency, specialization, and readiness for evolving coding technologies.

12. Directs the strategy and governance for external coding audits, independent reviews, specialty reviews, and other coding quality assessments; determines when external validation is appropriate based on risk and business need.

13. Establishes quality requirements, service expectations, audit methodologies, reporting standards, and performance measures for external coding partners and vendors.

14. Maintains executive accountability for quality validation of coding performed by external partners, including trend review, issue escalation, corrective action, and ongoing performance monitoring.

15. Serves as a senior partner to Compliance and Coding leadership on coding-related compliance reviews, regulatory changes, investigations, risk assessments, corrective action plans, and other high-priority coding matters.

16. Ensures centralized governance, documentation, and reporting of significant audit findings, education interventions, remediation activities, corrective actions, re-audits, risk status, and closure.

17. Develops and oversees enterprise quality monitoring and validation strategies for computer-assisted coding, AI-assisted coding, autonomous coding, and other emerging technologies that influence coding outcomes.

18. Partners with Epic/Information Technology, Compliance, Coding leadership, clinical and operational stakeholders, and technology vendors to evaluate automation accuracy, exceptions, overrides, workflow impact, controls, and emerging coding risks.

19. Establishes enterprise coding quality dashboards, key performance indicators, executive reporting, and benchmarking methodologies; communicates performance, trends, risks, and opportunities to senior leadership.

20. Develops annual and long-range priorities for the coding quality and education function, including resource planning, staffing models, vendor utilization, budget considerations, technology needs, and strategic initiatives aligned with Revenue Cycle and organizational goals.

 

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Prolonged periods of sitting at a desk and working on a computer.
2. Frequent use of hands and fingers to operate a computer and other office equipment.
3. Ability to communicate effectively through verbal, written, virtual, and electronic means.

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Standard office or remote work environment.

2. May require occasional travel to WVU Medicine facilities or other locations for meetings, leadership activities, training, audits, or operational needs.

3. Work may require participation in virtual meetings and collaboration with leaders, staff, and external partners across multiple locations and schedules.

SKILLS AND ABILITIES:
1. Expert knowledge of ICD-10-CM, ICD-10-PCS, CPT, HCPCS, official coding guidelines, reimbursement methodologies, payer requirements, and applicable regulatory standards.

2. Advanced knowledge of coding quality assurance, audit methodology, healthcare reimbursement, compliance principles, documentation requirements, and revenue integrity practices.

3. Demonstrated ability to lead enterprise programs, establish governance, translate strategic priorities into operational plans, and drive measurable performance improvement.

4. Strong analytical and critical-thinking skills with the ability to interpret complex coding quality data, identify enterprise trends and risks, and develop actionable recommendations for senior leadership.

5. Demonstrated leadership ability, including team development, coaching, performance management, succession planning, change leadership, and management through other leaders.

6. Excellent written, verbal, presentation, and executive communication skills, including the ability to communicate complex coding, compliance, and quality issues to varied audiences.

7. Ability to build effective partnerships across Coding, Compliance, Revenue Cycle, Information Technology, Finance, clinical, operational, and vendor teams in a complex matrixed environment.

8. Demonstrated ability to evaluate coding technology, automation, vendor performance, and emerging industry practices while balancing quality, compliance, operational efficiency, and organizational risk.

Additional Job Description:

Scheduled Weekly Hours:

40

Shift:

Exempt/Non-Exempt:

United States of America (Exempt)

Company:

SYSTEM West Virginia University Health System

Cost Center:

548 SYSTEM HIM Coding Analysis