Manager Coding & Documentation Analysis

Elevance Health•Tampa, FL

4d•Hybrid

About The Position

CareBridge Health, a member of the Elevance Health family of companies within Carelon, focuses on enabling individuals in home and community-based settings to maximize their health, independence, and quality of life through homecare and community-based services. This role is responsible for leading coding team operations to ensure high-quality documentation of clinical encounters and adherence to the latest diagnostic documentation guidelines and clinical best practices. The position requires 3 days per week in the office, with core hours from 8 AM to 5 PM, Monday through Friday. The hybrid model combines structured office engagement with virtual work flexibility. Alternate locations may be considered if candidates reside within a commuting distance from an office.

Requirements

BA/BS and minimum 5 years coding leadership experience, 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.

Nice To Haves

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).

Responsibilities

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.