Manager, Clinical Performance and Quality Coding
Elevance Health
full-time
Posted on:
Location Type: Hybrid
Location: Atlanta • Florida • Kentucky • United States
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About the role
- 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
Requirements
- 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
Benefits
- merit increases
- paid holidays
- Paid Time Off
- incentive bonus programs
- medical
- dental
- vision
- short and long term disability benefits
- 401(k) +match
- stock purchase plan
- life insurance
- wellness programs
- financial education resources
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
ICD-10 codingCMS Risk Adjustmentclinical quality reviewsHEDIS care opportunitiesperformance managementKPI developmentclinical documentationcoding initiativespeer reviewauditing
Soft Skills
leadershiptrainingcoachingcommunicationcollaborationperformance evaluationcounselinggoal alignmentfeedback incorporationorganizational skills
Certifications
Certified Medical Coder (CPC)Certified Coding Specialist (CCS-P)AAPC Certified Risk Adjustment Coder (CRC)