Director, Quality, Clinical Coding and Documentation
New
J
JobgetherHealthcare
Based in the United StatesFull-TimeDirector
Salary not disclosed
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Job Details
- Experience
- At least 7 years of progressive experience in medical coding, risk adjustment, or clinical documentation integrity, including 3+ years in a leadership or program ownership capacity.
- Required Skills
- EHR
Requirements
- Bachelor’s degree in health information management, nursing, healthcare administration, or related field.
- Active coding certification such as CPC, CRC, CCS, CCS-P, RHIA, or RHIT (CRC strongly preferred).
- Minimum 7 years of experience in medical coding, risk adjustment, or CDI, including 3+ years in leadership.
- Deep working knowledge of the CMS-HCC risk adjustment model (V24 to V28 transition).
- Experience building or substantially redesigning a risk adjustment or CDI program.
- Direct experience with RADV or payer audit response and medical record retrieval.
- Knowledge of ICD-10-CM guidelines and compliant provider query practices.
- Proven ownership of HEDIS and Medicare Advantage Star Ratings programs.
- Strong understanding of EHR systems, reporting tools, and healthcare analytics.
- Ability to educate and influence physicians and advanced practice clinicians.
Responsibilities
- Own HEDIS and Medicare Advantage Star Ratings strategy and performance.
- Lead end-to-end quality gap closure and clinical operations integration.
- Oversee supplemental data strategy and NCQA HEDIS submissions.
- Manage the end-to-end risk adjustment program, including CMS-HCC V28 compliance.
- Design and lead the clinical documentation integrity (CDI) program.
- Direct internal coding audits and manage RADV and payer audit readiness.
- Build, lead, and develop a multidisciplinary team spanning quality, coding, and CDI.
- Partner with clinical informatics to optimize EHR templates and workflows.
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