Program Integrity Director Jobs in Biddeford, ME

This is a remote based position. Applicants can be located nationwide

About You

You are a person who enjoys translating coding operations into measurable revenue cycle outcomes. We need someone who has a strong understanding of how documentation, charge capture, coding, claims generation, reimbursement methodology, payer edits, and denial management collectively impact organizations financial performance. In the role of Director of Coding Operations, you will be responsible for ensuring coding practices support claims generation, clean claim submission, optimal reimbursement, and appropriate revenue recognition.

• Tell us about your experience with Medical Coding Operations Leadership.
• Are you a team player and a self-motivator?
• What is your experience with conducting business in a way that is credit to a company?
• We are counting on you to manage multiple projects using your problem-solving skills.
• We are looking for someone UNCOMMON. What is uncommon about you?

Are you highly committed? Are you team-oriented? Do you value professionalism, trust, honesty, and integrity? If so, we cannot wait to meet you.

About The Position

• Maintain expert knowledge of healthcare revenue cycle operations and the impact of coding on reimbursement, revenue integrity, claims adjudication, and denial prevention.
• Ensure accurate application of revenue codes, bill types, condition codes, occurrence codes, occurrence span codes, value codes, discharge dispositions, and other claim elements impacting reimbursement.
• Partner with Revenue Integrity, Patient Financial Services, CDI, Case Management, and Client Operations teams to improve revenue cycle performance.
• Analyze coding-related denials, edits, underpayments, and reimbursement variances and implement corrective action plans.
• Support optimization of clean claim rates, DNFB reduction, charge capture effectiveness, and accounts receivable performance.
• Monitor changes in Medicare, Medicaid, commercial payer, and managed care reimbursement methodologies.
• Collaborate in the development of revenue cycle workflows that support accurate charge capture, coding, billing, and payment processes.
• Serve as a subject matter expert regarding the relationship between clinical documentation, coding, revenue codes, bill types, APCs, DRGs, HCPCS/CPT codes, and payer reimbursement methodologies.
• Review claim denials and rejections pertaining to coding and medical necessity issues and, when necessary, implement processes, such as educational programs, or revamp current processes to prevent similar denials and rejections from recurring.
• Guide performance from strategy through to frontline operations by giving the front-line information they need to know.
• This position is primarily remote; however, travel up to monthly may be required for client site visits, operational reviews, leadership meetings, onboarding activities, business development support, and industry conferences.

Minimum Requirements:

• Education
  
  • Associate's degree in Health Information Management or other healthcare-related field required
  • Bachelor's degree preferred
  
  
• Experience
  • 10 years' knowledge and experience in healthcare leadership required.
  • 10 years knowledge and experience in coding, information privacy, laws, access, security, release of information and access control technology required.
  
  
• Extensive knowledge of inpatient, outpatient, professional fee, and specialty coding operations, including ICD-10-CM/PCS, CPT, HCPCS, MS-DRGs, APR-DRGs, APCs, revenue codes, bill types, modifiers, condition codes, value codes, Medicare payment methodologies, and revenue cycle processes.
• Demonstrated experience analyzing the downstream impact of coding decisions on claims processing, reimbursement, denials management, revenue integrity, and net revenue performance.
• Strong understanding of hospital and physician revenue cycle workflows, including patient access, charge capture, coding, billing, claims management, denial prevention, payment posting, and accounts receivable management.
• Certifications Required:
  • RHIA/RHIT and CCS/CPC
  
  
  
  

Preferred Requirements:

• Experience with Revenue Integrity programs.
• Experience with Chargemaster (CDM) review and maintenance.
• Experience with denial management and appeals processes.
• Experience supporting Critical Access Hospitals, Rural Health Clinics, PPS hospitals, and physician practices.
• Knowledge of Medicare OPPS, IPPS, CAH reimbursement, physician fee schedule methodologies, and value-based reimbursement models.

About Us

You are uncommon. We are, too. We are looking for people to help us in our mission of working hard at lowering healthcare administrative costs for federal government agencies, payers, and providers. At Signature, our mission is to improve the health of our clients' business and make the lives of the people we work with better. As we continue to experience exponential growth, we are looking for uncommon individuals to enhance our vision. We will continue to accomplish our mission by leading with our values of Passion, Courage, Integrity, and Respect in all interactions, making us a consistent annual Best Places to Work organization. We need uncommon leaders with uncommon qualities to shape our uncommon culture and achieve our uncommon mission.

About the Benefits

When you are a member of Signature Performance, you are a part of a solutions-based organization where the values of passion, integrity, courage, and respect are the driving forces behind all our decision-making. We trust you to do important work and bring the best version of yourself to work every day, so we want to help you achieve a work-life balance while consistently challenging yourself. Signature believes in fully developing each one of our Associates. Our performance-driven philosophy boasts competitive pay and additional position specific incentives, where world-class training and development, resources, and events drive our award-winning culture where everyone thrives.

• Health Insurance
• Fully Paid Life Insurance
• Fully Paid Short- & Long-Term Disability
• Paid Vacation
• Paid Sick Leave
• Paid Holidays
• Professional Development and Tuition Assistance Program
• 401(k) Program with Employer Match

• U.S. Citizenship or naturalized citizenship is required for this position.
• All work on all positions at Signature Performance must be completed in the continental United States, Alaska, or Hawaii.