Position Summary

The Director of Health Information Management (HIM) leads and oversees the agency's health information infrastructure across a large-scale home health operation, ensuring the integrity, timeliness, and compliance of the clinical record from admission through discharge. This role has direct oversight of four critical functional areas: Medical Records, Audit Management (including the Review Choice Demonstration program), Orders Management, and Face-to-Face documentation. The Director partners closely with clinical operations, coding, billing/revenue cycle, quality, and compliance leadership to safeguard documentation integrity, minimize denials and takebacks, and ensure the agency meets all Medicare Conditions of Participation and payer-specific requirements. This role requires deep, hands-on proficiency with the Homecare Homebase (HCHB) EMR, as HCHB workflows, queues, and reporting are the primary operational tools for this position and its teams.

Essential Duties and Responsibilities

Medical Records Management

• Oversee the accuracy, completeness, timeliness, and legal integrity of the clinical record throughout the patient episode, from intake through discharge and archival.

• Ensure medical records staff maintain compliance with Medicare Conditions of Participation, state licensure requirements, and agency retention/destruction policies.

• Manage record amendment, addendum, and correction processes in accordance with HCHB documentation standards and legal medical record guidelines.

• Oversee release of information (ROI) processes, ensuring HIPAA-compliant handling of records requests from patients, physicians, payers, attorneys, and surveyors.

• Monitor documentation completion queues within HCHB to identify and resolve delinquent, missing, or unsigned documentation on a rolling basis.

• Establish and maintain policies and procedures for medical records governance, chart audits, and documentation standards across all disciplines.

Audit Management, Including the Review Choice Demonstration (RCD)

• Direct the agency's response to all external audits, including Additional Documentation Requests (ADRs), Targeted Probe and Educate (TPE) reviews, RAC, UPIC, SMRC, and MAC audits.

• Serve as the agency's subject matter expert on the Review Choice Demonstration, overseeing pre-claim review or postpayment review submissions depending on the agency's selected RCD choice and state requirements.

• Build and maintain RCD workflows within HCHB, including tracking affirmation/non-affirmation rates, resubmission timelines, and documentation packaging for MAC submission.

• Analyze audit outcomes, denial trends, and RCD affirmation data to identify root causes and implement corrective action plans with clinical and coding leadership.

• Prepare and present audit and RCD performance metrics, denial trends, and risk indicators to senior leadership and compliance committees.

• Maintain a proactive internal audit and documentation review program to identify compliance risks before external audit exposure occurs.

• Coordinate appeals for unfavorable determinations, ensuring timely, well-supported submissions through all appeal levels (redetermination through ALJ, as applicable).

Orders Management

• Oversee the full lifecycle of physician orders within HCHB, including verbal order intake, order generation, transmission, physician signature tracking, and timely return.

• Ensure all orders (plan of care/485, verbal orders, recertifications, and interim orders) are obtained, signed, and filed within regulatory timeframes to prevent non-billable or denied episodes.

• Monitor HCHB orders queues and aging reports to proactively resolve outstanding or overdue physician signatures, escalating aged orders per agency policy.

• Partner with intake, scheduling, and clinical teams to ensure orders align with certifying physician documentation and face-to-face requirements.

• Maintain relationships and communication workflows with referring physician offices to support timely order turnaround.

Face-to-Face (F2F) Encounter Compliance

• Oversee the tracking, collection, and clinical validity review of Face-to-Face encounter documentation to support home health eligibility for every certification and recertification.

• Ensure Face-to-Face documentation supports homebound status and skilled need narratives sufficiently to withstand medical review and RCD scrutiny.

• Manage HCHB Face-to-Face tracking queues, ensuring encounters are obtained within required timeframes and are appropriately linked to certification periods.

• Train and support clinical liaisons and intake staff on Face-to-Face requirements, physician education, and documentation red flags.

• Collaborate with physician relations/liaison staff to address recurring Face-to-Face documentation deficiencies with referral sources.

Leadership, Systems, and Cross-Functional Collaboration

• Hire, train, supervise, and evaluate HIM department staff, including Medical Records, Audit/RCD, Orders Management, and Face-to-Face teams.

• Serve as the department's HCHB subject matter expert, partnering with IT and HCHB support to optimize workflows, queues, alerts, and reporting relevant to HIM functions.

• Develop and monitor departmental KPIs (e.g., order turnaround time, F2F compliance rate, audit response timeliness, RCD affirmation rate, record completion rate) and report results to executive leadership.

• Partner with the coding, QAPI, compliance, and revenue cycle teams to identify documentation trends impacting reimbursement, survey readiness, and clinical quality.

• Lead or support survey readiness activities and represent HIM during state or accreditation surveys as needed.

• Stay current on CMS home health regulations, RCD program updates, and HCHB system changes, translating regulatory changes into updated policy and workflow.

Qualifications

Education & Certification

• Bachelor's degree in Health Information Management, Nursing, Health Administration, or related field required; Master's degree preferred.

• RHIA, RHIT, or active clinical licensure (RN preferred) strongly preferred.

• Coding credential (e.g., COS-C, HCS-D, CCS) a plus.

Experience

• Minimum 5–7 years of progressive experience in health information management, medical records, or compliance within home health or a related post-acute setting.

• Minimum 3 years in a leadership/supervisory role overseeing HIM, audit, or compliance functions.

• Direct, hands-on experience with the Review Choice Demonstration (RCD) program required.

• Required: substantial hands-on experience with the Homecare Homebase (HCHB) EMR, including orders, F2F, and documentation queues/reporting.

• Demonstrated experience managing Medicare/Medicaid audits, ADRs, TPE, and appeals processes.

Knowledge, Skills & Abilities

• Comprehensive knowledge of Medicare Conditions of Participation, home health Face-to-Face requirements, and CMS documentation standards.

• Strong analytical skills with the ability to interpret audit and denial data to drive process improvement.

• Excellent leadership, staff development, and cross-departmental collaboration skills.

• Strong written and verbal communication skills, including experience presenting to executive leadership.

• High attention to detail and ability to manage multiple regulatory deadlines simultaneously.

Work Environment & Physical Demands

Primarily an office-based role, which may include remote or hybrid arrangements depending on agency policy. Requires extended periods of computer use, occasional travel to branch locations, and the ability to manage high-volume, deadline-driven work across multiple regulatory programs.

NOTICE: Successful completion of a drug screen prior to employment is part of our background process, which includes medical and recreational marijuana.

By supplying your phone number, you agree to receive communication via phone or text.

By submitting your application, you are confirming that you are legally authorized to work in the United States.

JR# JR259393