Director - Quality HIM

About the role

Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success. ESSENTIAL DUTIES AND RESPONSIBILITIES: Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member's performance objectives as outlined by the Team Member's immediate Leadership Team Member. The Associate Director / Director of Quality & Transformation - Medical Coding is a strategic leadership role focused on driving operational excellence, maximizing coding accuracy, and leading digital and process transformation across the HIM organization. This role oversees the global medical coding quality assurance (QA) framework, ensures strict regulatory compliance, and champions the adoption of advanced automation tools (such as AI-driven Computer-Assisted Coding). The leader will turn audit insights into transformative operational strategies, directly impacting cash flow, reducing denials, and ensuring compliance.

Responsibilities

• Strategic Quality Governance
• Quality Framework: Architect, implement, and govern a comprehensive medical coding quality management strategy across all lines of business
• Audit Management: Oversee internal, external, and client-facing coding audit programs, ensuring coding accuracy consistently meets or exceeds the client SLAs.
• Denial Resolution: Partner with Denial teams to analyze rejection trends and implement immediate corrective action plans.
• Transformation, Automation & Innovation
• AI & Technology Adoption: Drive the evaluation, piloting, and scaling of automated coding technologies, Autonomous Coding systems, and AI-powered Computer-Assisted Coding (CAC) software.
• Process Engineering: Lead Lean Six Sigma or similar continuous improvement projects to eliminate workflow bottlenecks, minimize manual touchpoints, and reduce the cost-to-serve.
• Change Management: Manage the structural and cultural shift as teams transition from traditional manual coding roles to high-efficiency, technology-enabled validation roles.
• Client & Stakeholder Management
• Executive Reporting: Design and present high-impact quality dashboards, compliance risks, and transformation ROI metrics to the executive leadership team and external clients.
• SLA Compliance: Serve as the final escalation point for complex coding disputes, audit rebuttals, and contractual quality Service Level Agreement (SLA) reviews.
• Required Qualifications
• Education & Certifications
• Degree: Bachelor's degree in Health Information Management (HIM), Healthcare Administration, or a related field. An MBA, MHA, or equivalent Master's degree is highly preferred.
• Core Credentials: Must maintain active, premier credentials from AHIMA or AAPC :CCS (Certified Coding Specialist) / CPC (Certified Professional Coder)RHIA / RHIT (Registered Health Information Administrator / Technician)
• Transformation Certifications: Lean Six Sigma Green Belt or Black Belt certification is highly desirable.
• Experience & Skills
• Domain Expertise: Minimum of 12-15 years of coding experience, with at least 8-10 years in a dedicated quality management, auditing, or operational excellence leadership role.
• Transformation Track Record: Documented success in leading large-scale process transformation projects, EHR migrations, or automated coding software deployments.
• Geographic Scope: Proven experience managing large-scale quality operations across India
• PHYSICAL DEMANDS:
• A job description is only intended as a guideline and is only part of the Team Member's function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed

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