Director, Coding (athenaOne)

The Director, Coding leads the enterprise physician coding compliance, audit, provider education, and coding operations support functions for Panoramic Health. The role establishes a risk-based coding compliance program across nephrology, dialysis, ESRD, hospital, office, vascular, and other professional services; directs internal and external audits; and ensures findings result in timely corrective action, provider education, and re-audit. The Director oversees coding-related claim holds, vendor quality, staff performance, and cross-functional workflows with Revenue Cycle Management, Compliance, Medical Records, Operations, and practice leadership. The role also leads coding technology implementation, maintains provider coding profiles, and uses athenaOne and other platforms to identify documentation, coding, denial, reimbursement, and compliance risk. Providers remain responsible for selecting codes for their services; the Coding function supports them through audit, education, monitoring, and escalation.
Responsibilities include:

Provide enterprise leadership for physician coding compliance, coding audits, provider education, coding-related claim holds, and revenue integrity support across all practices and service lines.
Develop and execute an annual risk-based coding audit plan that addresses provider, practice, payer, procedure, documentation, and reimbursement risk, with defined sampling, scoring, escalation, corrective action, and re-audit standards.
Direct CMS, Medicare Administrative Contractor, Targeted Probe and Educate, Recovery Audit Contractor, commercial payer, and other external coding or documentation audits from notice through final resolution, including deadline control, record validation, submission, education, appeal support, and remediation.
Maintain subject matter expertise in nephrology, dialysis, and ESRD professional coding, including monthly capitation services, visit requirements, inpatient and outpatient E/M services, vascular access services, documentation standards, and payer-specific requirements.
Identify systemic coding and documentation risks, determine the affected provider, practice, payer, procedure, and date-of-service populations, quantify financial and compliance exposure, and coordinate appropriate escalation and corrective action.
Build and maintain provider coding profiles that summarize coding patterns, E/M distribution, modifiers, procedure utilization, denial trends, audit results, education history, repeat findings, and re-audit performance to support targeted intervention and ongoing monitoring.
Design, implement, and measure provider coding education based on audit findings, regulatory changes, documentation gaps, payer trends, and specialty-specific risks; coordinate content review and approval with Compliance and clinical leadership.
Oversee coding-related claim hold inventories and work queues, establish service levels, monitor aging and financial impact, assign work based on root cause and required corrective action, and ensure timely handoffs to AR, Medical Records, Operations, or practices when coding action is not required.
Establish quality standards and controls for onshore staff, offshore teams, and external vendors, including calibration, inter-rater reliability, quality sampling, productivity expectations, remediation, and performance reporting.
Lead implementation and optimization of coding, audit, education, and workflow technology, including requirements definition, workflow design, configuration input, testing, validation, training, adoption, access controls, and post-implementation monitoring.
Use athenaOne and supporting analytics to evaluate coding-related claim activity, documentation, holds, denials, reimbursement trends, and provider variation; validate that reports reconcile to operational work queues and source data.
Create and maintain policies, standard operating procedures, decision trees, routing rules, and accountability matrices for coding audits, medical record requests, provider education, coding holds, and cross-functional issue resolution.

Qualifications:

Bachelor's degree in Health Information Management, Healthcare Administration, Business, Finance, or a related field is preferred; an equivalent combination of education and relevant experience may be considered.
Current professional coding certification in good standing is required, such as Certified Professional Coder (CPC) through AAPC or Certified Coding Specialist Physician-based (CCS-P) through AHIMA.
Additional auditing or compliance credentials, such as CPMA, CHC, or an equivalent credential, are preferred.
7+ years of progressive professional coding, coding compliance, auditing, provider education, or revenue integrity experience is required.
3+ years of leadership experience with responsibility for staff performance, workload, quality, and operational outcomes is required.
Direct nephrology, dialysis, and ESRD professional coding experience is strongly preferred.
Experience managing CMS, payer, provider, or enterprise coding audits and implementing corrective action is required.
Hands-on athenaOne experience is required.
Experience implementing coding, audit, workflow, analytics, or automation technology is required.
Experience leading onshore and offshore teams or external coding and audit vendors is strongly preferred.