Lead Director, Coding Audit & Compliance
Core
Provide strategic leadership and organizational oversight for Coding Audit and Compliance functions to ensure accurate, complete, and consistent coding in accordance with CMS requirements and regulatory guidelines.
Role type
Senior Director, Coding Audit & Compliance
Builds
Risk-based audit programs, compliance standards, and governance frameworks for internal and external coding operations
Domain
Healthcare administration and medical coding compliance
Deliverable
dashboards & analysis
Required skills
Strategic leadership, risk-based audit program design, regulatory compliance (CMS/ICD-10-CM), root-cause analysis, vendor governance, analytics interpretation, technology strategy for coding automation, talent development
Preferred skills
Experience leading managers and multiple functional teams, Medicare risk adjustment expertise
Technologies
Business Intelligence reporting tools, coding application development platforms, AI/NLP-assisted coding solutions
Responsibilities
Develop and oversee comprehensive risk-based Coding Audit Programs; Establish coding quality and compliance standards across internal and external resources; Monitor regulatory changes and evaluate impact on operations; Lead readiness activities for CMS RADV and OIG reviews; Advise executive leadership on material coding risks; Provide leadership and coaching to Coding Audit and Compliance staff
Seniority
Director, strategic leadership & team management
