Responsible for leading the quality documentation, coding and value capture for all provider visit medical encounters to ensure application of accurate diagnosis codes (ICD-10 codes)
Serves as the primary resource and subject matter expert on all CMS Risk Adjustment and quality documentation
Develop and deliver training on advance coding and documentation while incorporating coder feedback
Lead the coding department and coding initiatives
Liaison to the clinical leadership on alignment of goals and workflows to support value capture initiatives and high-quality clinical documentation
Develop performance management plan, KPI's and clinical level tracking to meet quarterly goals for coding timeliness, accuracy, and Risk Adjustment
Develop and manage clinical quality reviews to ensure peer review and clinical quality chart audit process including targeting chart reviews, auditing percentages, score guidelines feedback mechanism and ensure compliance with remediation procedures
Develop operational and clinical workflows for closing HEDIS care opportunities to ensure practices and health plan success
Participate in peer review of medical documentation for completed visits notes as well as patient profile information in EMR
Hires, trains, coaches, counsels, and evaluates performance of direct reports

Requires a bachelor in Nursing
at least 3 years clinical exp in applying appropriate diagnosis in the Medicare HCC Mode
Current, active, unrestricted license as RN, NP, or PA in applicable state(s)
Requires experience with CMS Risk Models
Certified Medical Coder (CPC , CCS-P) is a must for this position!
Previous management/supervisory experience is strongly preferred
Experience with the most current CMS Risk Adjustment Model strongly preferred
AAPC Certified Risk Adjustment Coder (CRC) is preferred

Manager, Clinical Performance and Quality Coding

Key skills