Director of Coding-CDI-HIM

Why work for Nebraska Methodist Health System?

At Nebraska Methodist Health System, we focus on providing exceptional care to the communities we serve and people we employ. We call it The Meaning of Care – a culture that has and will continue to set us apart. It’s helping families grow by making each delivery special, conveying a difficult diagnosis with a compassionate touch, going above and beyond for a patient’s needs, or giving a high five when a patient beats a disease or conquers a personal health challenge. We offer competitive pay, excellent benefits and a great work environment where all employees are valued! Most importantly, our employees are part of a team that makes a real difference in the communities we live and work in.

Job Summary

Location: Methodist Corporate Office

Address: 825 S 169th St. - Omaha, NE

Provides strategic leadership and oversight for revenue cycle operations related to coding, clinical documentation, and health information management across Nebraska Methodist Hospital. Responsible for Clinical Documentation Improvement (CDI), Utilization Management, Tumor Registry, Health Information Management (HIM), and Transcription Services, ensuring regulatory compliance, operational efficiency, and the integrity of the legal medical record. Collaborates with leaders across the revenue cycle, affiliates, legal, and compliance functions to optimize processes, support reimbursement accuracy, and maintain adherence to accreditation and regulatory standards.

Responsibilities

Essential Functions

Directs coding for Nebraska Methodist Hospitals and hospital-based outpatient clinics (System Wide) (35%)

• Manages internal and external coding resources to ensure the timely, accurate, and compliant assignment of diagnoses and procedures, supporting appropriate severity of illness and intensity of service capture.
• Oversees concurrent coding activities in partnership with the Clinical Documentation Improvement (CDI) team to enhance documentation accuracy and optimize reimbursement.
• Directs the administration, maintenance, and optimization of coding software, encoders, computer-assisted coding (CAC) tools, and related system applications.
• Establishes and monitors coding quality and productivity standards, ensuring staff performance meets or exceeds organizational expectations.
• Ensures coding compliance through ongoing monitoring, education, and periodic internal and external audits, implementing corrective actions as needed.
• Leverages advanced coding technologies and automation tools to improve coding accuracy, completeness, efficiency, and regulatory compliance.
• Oversees the full lifecycle of Recovery Audit Contractor (RAC) and Targeted Probe and Educate (TPE) audits, including audit tracking, documentation collection, response preparation, coordination with clinical and revenue cycle teams, appeal support, and adherence to CMS requirements and submission deadlines.

Clinical Documentation Improvement (CDI) (20%)

• Provides leadership and oversight of the Clinical Documentation Improvement (CDI) program, ensuring completion of daily concurrent and follow-up reviews, timely physician query resolution, ongoing provider education, and collaboration with coding staff to support accurate DRG assignment and reimbursement.
• Builds and maintains a high-performing CDI team capable of effectively engaging physicians and other clinical practitioners to improve documentation quality and accuracy.
• Develops and delivers physician education initiatives to ensure clinical documentation accurately reflects patient acuity, severity of illness, risk of mortality, quality outcomes, and resource utilization.
• Oversees staff training, competency development, quality assurance reviews, and onboarding/orientation programs for new physicians and clinical practitioners related to documentation and coding best practices.
• Champions industry best practices in clinical documentation integrity, promoting accurate and complete capture of patient care that supports compliant coding, quality reporting, and reimbursement outcomes.
• Analyzes and monitors key performance indicators, including case mix index (CMI), severity of illness (SOI), risk of mortality (ROM), and CC/MCC capture rates, identifying trends and opportunities for targeted physician and coder education and process improvement.

Oversees Utilization Management for hospitals (20%)

• Provides leadership and oversight of utilization management processes to ensure timely acquisition and extension of payer authorizations, supporting appropriate reimbursement and continuity of care.
• Collaborates with commercial, government, and other third-party payers to facilitate authorization approvals, resolve coverage issues, and ensure compliance with payer requirements.
• Oversees the provision of clinical review information that accurately reflects the patient's condition, treatment plan, level of care, and medical necessity to support authorization …