Director HIMS

Job Details

HIMS | Miamisburg | Full-time | First Shift

Responsibilities & Requirements

The Director of Hospital Coding and Clinical Documentation Integrity provide strategic and operational leadership for hospital coding and CDI programs across the Kettering Health system. This role oversees inpatient and outpatient coding operations, CDI program performance, documentation improvement strategies, coding productivity and quality standards, denial prevention, and audit readiness. The Director ensures compliance with federal, state, payer, and organizational requirements while partnering closely with Utilization Management, Physician Advisors, Medical Staff, Quality, Finance, and service line leaders to advance key revenue cycle performance indicators. Performs other duties as assigned.

Minimum Education

• Bachelor's degree in Health Information Management, Nursing, Healthcare Administration, or a related field required

Work Experience

• Minimum of 5 years of progressive experience in hospital coding, clinical documentation integrity, health information management, revenue cycle, compliance, or related healthcare operations required
• Minimum of 3 years of leadership experience managing coding, CDI, HIM, revenue cycle, audit, or related teams

Skills

• Demonstrated leadership, communication, collaboration, and change management skills with ability to inspire and align diverse teams
• Advanced knowledge of hospital coding, CDI, reimbursement, compliance, quality reporting, and revenue cycle operations
• Ability to interpret complex regulatory guidance (ICD-10-CM/PCS, MS-DRG, APC, CMS, OIG) and translate it into practical, compliant operational workflows
• Strong analytical skills with ability to use data to identify trends, measure performance, and drive improvement
• Ability to lead through influence across clinical, operational, financial, and executive stakeholders
• High degree of integrity, judgment, confidentiality, and professionalism
• Strong understanding of physician engagement, provider education, and multidisciplinary program leadership including CDI query best practices and documentation improvement initiatives
• Ability to manage competing priorities in a complex, fast-paced healthcare environment

Essential Functions

Strategic Leadership

• Provide leadership and strategic direction for hospital coding and CDI operations across the organization.
• Advance the development of strategic goals, performance metrics, and operational plans that align with health system objectives, regulatory requirements, and revenue cycle priorities.
• Lead initiatives that improve coding accuracy, documentation completeness, case-mix index, risk adjustment, denial prevention, quality outcomes, and reimbursement integrity.
• Serve as a strategic advisor on coding, CDI, DRG assignment, documentation standards, and regulatory updates on organization committees.

Coding Operations Oversight

• Advance hospital coding functions, including inpatient, outpatient, observation, emergency department, same-day surgery, ancillary, and other applicable hospital-based coding areas.
• Ensure timely, accurate, and compliant coding in accordance with ICD-10-CM/PCS, CPT, HCPCS, MS-DRG, APR-DRG, CMS requirements, payer policies, and organizational standards.
• Monitor DNFB and Coding AR Days to ensure market strength is prioritized.
• Advance the development of coding policies, SOPs, workflows, staff education, and quality assurance programs.
• Evaluate staffing models, vendor support, technology, automation, and workflow optimization opportunities to improve efficiency and accuracy.

Clinical Documentation Integrity Leadership

• Lead the CDI program strategy to support accurate and complete provider documentation reflecting patient acuity, severity of illness, risk of mortality, clinical complexity, and resource utilization.

• Advance the strategy of CDI review processes, query practices, physician education, documentation improvement initiatives, and CDI productivity and quality metrics.

• Ensure CDI practices comply with ACDIS/AHIMA query guidelines, CMS regulations, coding guidelines, payer requirements, and organizational compliance standards.

• Collaborate with CDI manager and department leaders, clinical providers, service line leaders, and system leadership to improve documentation practices and reduce documentation-related denials.

• Promote effective partnership between CDI, Coding, Quality, Utilization Management, Physician Advisors, and denials teams.

• Compliance, Audit, and Regulatory Accountability

• Lead internal and external audit response activities related to coding, CDI, DRG validation, medical necessity, quality measures, and payer reviews.

• Partner with Compliance and Legal teams to evaluate risk, respond to audit findings, and implement corrective action plans.

• Ensure operations are proactive to regulatory changes, OIG work plans, CMS updates, coding clinic guidance, payer policy changes, and industry trends.

• Maintain strong documentation of policies, decisions, coding guidance, and service line agreements to support audit defensibility.

Denial Prevention and Revenue Integrity

• Develop and lead action plans to reduce preventable denials related to coding and CDI practices.
• Analyze denial trends, audit findings, query outcomes, DRG shifts, and payer behavior to support proactive education and process improvement.

Leadership Capabilities

• Demonstrates vision and strategic thinking; sets direction and aligns teams toward organizational goals.
• Builds high-performing teams; fosters a culture of accountability, continuous learning, and professional growth.
• Leads through influence across multidisciplinary teams; builds trust with physicians, clinical staff, compliance, finance, and executive leadership.
• Drives performance improvement; uses data and metrics to identify opportunities and sustain results.
• Communicates effectively with executive leadership, operational partners, and frontline teams; presents complex information clearly.
• Manages change with professionalism and resilience; adapts strategies in a dynamic healthcare regulatory environment.
• Reports to Executive Director Revenue Cycle Clinical Operations. Direct reports include Coding Managers and CDI Managers.

Preferred Qualifications

• Master's degree preferred
• Experience in a multi-hospital health system or academic medical center
• Experience with DRG validation, payer audits, RAC, MAC, OIG, commercial payer denials, clinical validation denials, and appeal strategy
• Experience with Epic, Solventum 360 Encompass, and revenue cycle analytics tools
• Experience with vendor oversight, contract management, and performance accountability for coding, CDI, or revenue cycle vendors

Licenses, Certifications and Registrations

One or more of the following credentials preferred (not all required):

• RHIA or RHIT (Registered Health Information Administrator / Technician)
• CCS (Certified Coding Specialist)
• CCDS (Certified Clinical Documentation Specialist) or CDIP (Clinical Documentation Improvement Practitioner)
• RN with CDI/coding leadership experience

Overview

Kettering Health is a not-for-profit system of 14 medical centers and more than 120 outpatient facilities serving southwest Ohio. Our mission is to live God's love by promoting and restoring health. Our commitment to our patients is to help individuals be their best. With that context, safety is our top priority. We provide an integrated system of healthcare experts committed to providing exceptional care.