Anticipated End Date:2026-06-06
Position Title:Manager Coding & Documentation Analysis
Job Description:Manager Coding & Documentation Analysis
LOCATION: Requires 3 days per week in the office. You must be within a reasonable commute of one of our eligible offices.HOURS: General business hours, Monday through Friday. (Core hours: 8-5)Hybrid 2: This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office.
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.
Primary duties may include, but are not limited to:
- 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.
- Execute day-to-day coding operations and ensure 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).
- Develop and iterate team workflows, KPI's, 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.
- Implements clear details on percentage of encounters reviewed, rubrics based on latest Medicare and State Medicaid guidelines, translation of review findings into frontline coaching, and criteria for coder performance management.
Required Qualifications- Requires a BA/BS and minimum 5 years coding leadership exp, 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.
Preferred Qualifications- 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).
Job Level:Manager
Workshift:1st Shift (United States of America)
Job Family:MED > Medical Ops & Support (Non-Licensed)
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
NOTE:
