Responsible for leading coding team operations to drive high-quality documentation of clinical encounters and ensure adherence to the latest diagnostic documentation guidelines and clinical best practices.
Serves as the primary resource and subject matter expert on all Medicare and Medicaid clinical documentation.
Participates in all consultations related to coding and clinical documentation and creation of policy briefs for leadership.
Executes day-to-day coding operations and ensures high-quality coding of diagnoses against ICD-10 and CPT classification systems.
Drives high performance on coding team KPIs (e.g., turnaround times, claim denial rate due to technical issues, secondary review scores).
Develops and iterates team workflows, KPIs, and associated reporting to meet quarterly goals for coding timeliness and quality.
Maintains high performance through operational efficiency and ongoing business optimization.
Develops and implements strategy for quality reviews of coder performance and associated coaching.

Requires a BA/BS and minimum 5 years coding leadership experience, or any combination of education and experience which would provide an equivalent background.
Experience with various Risk Models including CMS is required.
Experience with regulations relating to Medicare, Medicaid, and commercial insurance providers is required.
Certified Medical Coder (CPC or CCS-P) is a must for this role.
CPMA (Certified Professional Medical Auditor) and/or CRC (Certified Risk Adjustment Coder) certification preferred.
Strong analytical skills, including experience conducting exploratory analyses in Microsoft Excel is preferred (bonus if SQL-savvy).

Manager, Coding & Documentation Analysis

Key skills