Dir of Professional Coding and Validation

SUMMARY:

The Director of Professional Coding and Validation is responsible for leading Brown University Health/BHMG’s physician/professional coding and validation functions, ensuring accuracy, compliance, and operational excellence. This leader directs coding operations, audit/validation programs, and staff development to drive high-quality outcomes, optimal revenue capture, timely coding of diagnoses and procedures, improved documentation practices, and regulatory adherence. The Director will manage a large team of coding professionals, collaborate with revenue cycle, compliance, clinical, and executive leadership, and advance coding integrity to support organizational goals.

Brown University Health employees are expected to successfully role model the organization’s values of Compassion, Accountability, Respect and Excellence, as these values guide our everyday actions with patients, customers and one another. In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done.

The core Success Factors include:

Instill Trust and Value Differences Patient and Community Focus and Collaborate In addition, our leaders will demonstrate an aptitude for: Ensure Accountability and Build Effective Teams Drive Vision and Purpose and Optimize Work Processes By applying core and leadership competencies, leaders help Brown University Health achieve its strategic goals.

RESPONSIBILITIES:

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  Provide strategic direction and oversight for professional coding and validation teams. Develop and implement policies, workflows, and quality assurance measures that ensure compliance, efficiency, and effectiveness.

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  Establish and monitor key performance indicators (KPIs) to track coding accuracy, productivity, audit outcomes, and financial performance.

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  Stay current on regulatory changes and lead organizational readiness for updates.

Coding & Validation Oversight

Ensure accurate assignment of CPT, HCPCS, and ICD-10-CM codes for multi-specialty physician/professional services.

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  Oversee validation processes to confirm coding accuracy, charge capture, and clinical documentation alignment.

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  Monitor, evaluate and educate external coders, both on-shore and off-shore. Direct internal and external coding audits, monitor results, implement corrective action plans, and report results to Brown University Health’s leadership.

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  Collaborate with physicians and clinical staff to resolve documentation gaps and minimize denials.

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  Partner with IS and physicians to enhance templates to reduce physician burden while improving documentation.

Compliance & Quality

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  Ensure coding practices meet CMS, OIG, payer, and organizational compliance standards.
• Develop and oversee coding education programs for staff and providers.
• Monitor audit findings, identify trends, and proactively implement process improvements. Team Management & Development
• Recruit, train, and lead coding managers, supervisors, coders, validators and coding quality reviewers and educators. Foster a culture of accountability, collaboration, continuous improvement, and professional growth.
• Provide mentorship, coaching, and performance feedback to ensure team success. Develop and implement comprehensive training and certification programs to maintain staff competency and coding accuracy.

Collaboration & Reporting

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  Partner with revenue cycle, compliance, finance, IT, and clinical leadership to align coding and validation with organizational objectives.
• Participate in new department build in Epic to assure appropriate workflows and coding accuracy.
• Provide regular reporting and insights to senior leadership on coding accuracy, audit trends, denial drivers, and financial impact.
• Serve as the subject matter expert and organizational representative for internal and external audits, inspections, and accreditation reviews.

Qualifications Education:

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  Bachelor’s degree in health information management, Health Informatics, Business Administration, or related field required.

• Master’s degree preferred. Certifications: • Active coding certification required (e.g., CPC, CCS-P, RHIA, RHIT).

Experience:

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  Minimum of 7–10 years of progressive experience in coding, with at least 5 years in a management or leadership role.

• Demonstrated expertise in ICD-10, CPT coding systems, and revenue cycle processes. Proven success in leading large teams, driving process improvements, and managing remote coding operations. •

• Familiarity with major EHR systems (Epic, Cerner, etc.) and computer-assisted coding tools. • Demonstrated success in denial prevention, audit readiness, and process optimization. Skills & Competencies: • In-depth knowledge of coding, regulatory requirements, and compliance. Strong analytical skills with the ability to interpret complex data and implement operational improvements. • Excellent communication, leadership, and interpersonal skills; able to collaborate across departments and influence at all levels. • • Proficiency in EHR systems and health information technology.

Supervision

Direct supervisory responsibility for up to 120 FTEs across coding and validation functions

Pay Range:

$134,035.20-$221,187.20

EEO Statement:

Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment.

Location:

Remote-Rhode Island - N/A Providence, Rhode Island 02901

Work Type:

M-F 8:00am-5:00pm

Work Shift:

Day

Daily Hours:

8 hours

Driving Required:

No