Manager Clinical Performance & Quality Coding

Elevance Health • Atlanta, GA

2d • Hybrid

About The Position

Manager Clinical Performance & Quality Coding CareBridge Health is a proud member of the Elevance Health family of companies, within our Carelon business. CareBridge Health exists to enable individuals in home and community-based settings to maximize their health, independence, and quality of life through homecare and community-based services. LOCATION : This position requires 3 days per week in-office. You must be within a commutable distance of one of our aligned 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. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law. 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).

Requirements

• Requires a bachelor in Nursing and at least 3 years clinical exp in applying appropriate diagnosis in the Medicare HCC Mode; or any combination of education and experience, which would provide an equivalent background.
• Current, active, unrestricted license as RN, NP, or PA in applicable state(s) required.
• Requires experience with CMS Risk Models.

Nice To Haves

• Certified Medical Coder (CPC , CCS-P) is a must for this position!
• Previous management/supervisory experience is strongly preferred.
• BA/BS in Health Care or Business preferred.
• Experience with the most current CMS Risk Adjustment Model strongly preferred
• AAPC Certified Risk Adjustment Coder (CRC) is preferred.

Responsibilities

• 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.

Benefits

• We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Number of Employees: 5,001-10,000 employees