Director, PB Coding Operations & Education

Boston Medical Center (BMC); United States; On-site; USD 122,000 - 177,000; Full time

Job summary

Boston Medical Center leads a national program in PB coding operations and education, ensuring accurate, compliant coding and appropriate reimbursement across BUMG. The Director oversees operational execution, staff development, and policy adherence within Revenue Cycle.

The role emphasizes training providers and coders, coordinating with leadership, and maintaining awareness of coding guidelines, payer rules, and regulatory standards to sustain high-quality performance.

Qualifications

• Bachelor's degree or equivalent combination of education and experience.
• CPC certified professionally for coding operations and education.
• Minimum of 10 years of related professional coding experience with supervision.
• Experience in education/mentoring/training of staff required.

Responsibilities

• Provide coding oversight and standards for accuracy and compliance.
• Direct coding activities to ensure compliant coding for all services.
• Conduct quality reviews to validate coding accuracy.
• Lead education and mentoring programs for providers and staff.

Skills

ICD-9/10 knowledge

CPT/E/M knowledge

Payer reimbursement knowledge

Communication skills

Critical thinking

Mentoring

Education

Bachelor's degree or equivalent

CPC Certification

Tools

MS Office

APG/EAPG systems

APR DRG knowledge

Job description

Position Summary

The Director PB Coding Operations and Education functions primarily on providing coding oversight and standards to ensure coding accuracy, compliance and appropriate reimbursement across BUMG, along with managing operational execution of these standards in areas reporting to Revenue Cycle. The Director has responsibility for managing coding operations and overall success of an effective program, including oversight for coding training across BUMG. The Director manages coding staff to ensure compliance with coding guidelines, regulatory agencies and that appropriate reimbursement is received for the level of service rendered.

Position Summary

The Director PB Coding Operations and Education functions primarily on providing coding oversight and standards to ensure coding accuracy, compliance and appropriate reimbursement across BUMG, along with managing operational execution of these standards in areas reporting to Revenue Cycle. The Director has responsibility for managing coding operations and overall success of an effective program, including oversight for coding training across BUMG. The Director manages coding staff to ensure compliance with coding guidelines, regulatory agencies and that appropriate reimbursement is received for the level of service rendered.

Position: Director, PB Coding Operations & Education

Department: Corporate PBO General

Schedule: Full Time

Essential Responsibilities / Duties

The Director, Professional Coding Operations and Education functions primarily on providing coding oversight and standards to ensure coding accuracy, compliance and appropriate reimbursement across BUMG, along with managing operational execution of these standards in areas reporting to Revenue Cycle.

• Facilitate accurate representation of professional coding and clinical documentation through interaction with physicians, coders and practice staff by providing ongoing education
• Direct coding activities to ensure accurate, consistent and compliant coding for all services.
• Ensure quality reviews to validate coding accuracy.
• Participate in the rejections, denials and claims review process with billing team to ensure compliance and accurate reimbursement
• Identify trends in documentation and coding concerns and collaborate with Leadership and Compliance to assess and implement corrective action
• Evaluate the success of coding processes on an ongoing basis
• Serves as contact for professional coding across BUMG.
• Works with Human Resources and department mangers on the selection of qualified candidates for employment following all policies, guidelines and applicable laws
• Responsible for effective personnel management including training, directing, mentoring and instilling a commitment to quality and excellence
• Monitors department productivity and performance to identify and evaluate program/department strengths and training opportunities in relation to operative effectiveness
• Encourage staff and personally advances professional growth and development through participation in educational programs, workshops and maintaining knowledge of industry standards and practices.
• Must adhere to all of BMC's RESPECT behavioral standards.

JOB REQUIREEMNTS

Education

Bachelor's degree or equivalent combination of formal education and experience.

Certificates, Licenses, Registrations Required

CPC - Certified Professional Coder

Experience

Minimum of 10 years related experience in professional coding with ICD-9/ICD-10, E/M and CPT. Previous management experience required; experience must include education/mentoring/training.

Knowledge And Skills

• Expertise knowledge of ICD-9/ICD-10, CPT and E&M coding principals and guidelines
• Knowledge of MS, AP, and APR DRG systems APG, EAPGs
• Knowledge of payer reimbursement methodologies, federal, state and payer specific regulations, policies and compliance standards
• Excellent written verbal and communication skills
• Excellent critical thinking skills
• Excellent skill in providing hands-on education to providers including audit finding and improvement opportunities.
• Excellent organizational skills, including ability to multi-task, prioritize essential tasks, follow-through and meet timelines.
• Ability to work cooperatively with members of the healthcare delivery team and staff,
• Ability to adapt to changes in workload and priorities, responding quickly to urgent requests.
• Ability to mentor, guide and motivate direct reports through demonstration of best practices and leading by example.

Compensation Range

$122,000.00- $177,000.00

This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensures as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, BMCHS offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), discretionary annual bonuses and merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family well-being.

NOTE

This range is based on Boston-area data, and is subject to modification based on geographic location.

Equal Opportunity Employer/Disabled/Veterans