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Manager, Clinical Documentation and Coding Accuracy
WellvanaManager leading clinical documentation and coding accuracy for Wellvana, improving healthcare quality. Overseeing audits, training, and compliance within healthcare risk adjustment practices.
About the role
Key responsibilities & impact- Lead risk adjustment coding reviews, audits, and education programs that drive coding accuracy, regulatory compliance, and clinical documentation improvement (CDI) across the organization
- Conduct regular audits of risk adjustment coding/auditing practices, identify gaps, and provides targeted training and support to resolve them
- Analyze coding data to detect trends, patterns, and compliance risks, then translate findings into actionable improvements that reduce errors and strengthen risk adjustment practices
- Monitor changes in coding regulations and policies, and ensure timely organizational compliance
- Design and deliver coding education programs for staff and clients covering CDI, coding best practices, and regulatory compliance
- Define key metrics and performance indicators, monitor operating results, and drive corrective action/performance coaching when targets are not met
- Lead recruitment, onboarding, and ongoing development of coding/auditing staff, ensuring performance management practices align with applicable laws and regulations
- Own escalated coding/auditing and compliance issues through to timely, appropriate resolution
- Partner with internal departments to align on service standards and support consistent, high-quality coding/auditing outcomes
- Document and improve coding/auditing processes and workflows to increase efficiency and consistency
- Track and report on coding/auditing performance metrics, ensuring full adherence to policies and governmental and HIPAA compliance requirements
- Handle all Protected Health Information (PHI) in strict accordance with HIPAA requirements
Requirements
What you’ll need- Bachelor’s degree in a related field and/or the equivalent combination of training, education, and/or experience, required
- Certified coding credential from AAPC or AHIMA required; CPMA, CDEO, or CRC strongly preferred
- 3+ years of coding/auditing management/leadership experience required; 5+ years in multi-facility and/or vendor risk adjustment and quality operations strongly preferred
- Expertise in consulting, process reengineering, shared services, and project management within risk adjustment and quality assurance programs
- Proficiency in MS Office; ability to quickly learn job-specific software systems
- Clear and effective verbal and written communication skills
- Strong analytical and problem-solving skills, with the ability to translate data into actionable decisions
- Meticulous attention to detail with a consistent commitment to accuracy in risk adjustment and quality
Benefits
Comp & perks- Health insurance
- 401(k) matching
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
risk adjustment codingcoding auditsclinical documentation improvementdata analysisperformance metricsprocess reengineeringproject managementcoding best practicesregulatory complianceHIPAA compliance
Soft Skills
leadershipcommunicationanalytical skillsproblem-solvingattention to detailtraining and supportperformance managementcollaborationcoachingorganizational skills
Certifications
Certified coding credentialCPMACDEOCRC