What are the responsibilities and job description for the Manager, Clinical Documentation and Coding Accuracy position at Wellvana?
Description
Description
The healthcare system isn’t designed for health. We’re designed to change that. We’re Wellvana, and we help doctors deliver life-changing healthcare.
Through our elevated value-based care programs, we’re revitalizing an antiquated system that’s far too long relied on misaligned incentives that reward quantity of care not the quality of it.
Our enlightened approach—covering everything from care coordination to clinical documentation education to marketing— ties the healthy outcomes of patients directly to shared savings for primary care providers, health systems and payors.
Providers in our curated network keep their independence, reduce their administrative headaches, and spend more time with patients. Patients, in turn, get an elevated experience with coordinated care between appointments that is nothing short of life-changing.
Named a 2024 "Best in Business" and 2023 "Best Place to Work" by Nashville Business Journal, we’re one of the fastest-growing healthcare companies in America because what we do works. This is the way medicine is meant to be.
Clarity On The Role
The Manager of Clinical Documentation and Coding Accuracy leads risk adjustment coding reviews, audits, and education programs that drive coding accuracy, regulatory compliance, and clinical documentation improvement (CDI) across the organization. This role partners with coding/auditing staff and vendors, physicians, and healthcare providers to uphold best practices, strengthen financial integrity, and support quality patient care. Reports directly to the Sr. Director of Accurate Clinical Documentation.
What's Expected
What’s Required:
Description
The healthcare system isn’t designed for health. We’re designed to change that. We’re Wellvana, and we help doctors deliver life-changing healthcare.
Through our elevated value-based care programs, we’re revitalizing an antiquated system that’s far too long relied on misaligned incentives that reward quantity of care not the quality of it.
Our enlightened approach—covering everything from care coordination to clinical documentation education to marketing— ties the healthy outcomes of patients directly to shared savings for primary care providers, health systems and payors.
Providers in our curated network keep their independence, reduce their administrative headaches, and spend more time with patients. Patients, in turn, get an elevated experience with coordinated care between appointments that is nothing short of life-changing.
Named a 2024 "Best in Business" and 2023 "Best Place to Work" by Nashville Business Journal, we’re one of the fastest-growing healthcare companies in America because what we do works. This is the way medicine is meant to be.
Clarity On The Role
The Manager of Clinical Documentation and Coding Accuracy leads risk adjustment coding reviews, audits, and education programs that drive coding accuracy, regulatory compliance, and clinical documentation improvement (CDI) across the organization. This role partners with coding/auditing staff and vendors, physicians, and healthcare providers to uphold best practices, strengthen financial integrity, and support quality patient care. Reports directly to the Sr. Director of Accurate Clinical Documentation.
What's Expected
- Audit and Compliance: Conduct regular audits of risk adjustment coding/auditing practices, identify gaps, and provides targeted training and support to resolve them.
- Data Analysis and Strategy: Analyze coding data to detect trends, patterns, and compliance risks, then translate findings into actionable improvements that reduce errors and strengthen risk adjustment practices.
- Regulatory Updates: Monitor changes in coding regulations and policies, and ensure timely organizational compliance.
- Education and Training: Design and deliver coding education programs for staff and clients covering CDI, coding best practices, and regulatory compliance.
- Performance Management: Define key metrics and performance indicators, monitor operating results, and drive corrective action/performance coaching when targets are not met.
- Team Development: Lead recruitment, onboarding, and ongoing development of coding/auditing staff, ensuring performance management practices align with applicable laws and regulations.
- Issue Resolution: Own escalated coding/auditing and compliance issues through to timely, appropriate resolution.
- Cross-Functional Collaboration: Partner with internal departments to align on service standards and support consistent, high-quality coding/auditing outcomes.
- Process and Workflow Development: Document and improve coding/auditing processes and workflows to increase efficiency and consistency.
- Performance Metrics: Track and report on coding/auditing performance metrics, ensuring full adherence to policies and governmental and HIPAA compliance requirements.
- HIPAA Compliance: Handle all Protected Health Information (PHI) in strict accordance with HIPAA requirements.
What’s Required:
- Integrity: The right way is the only way.
- Dependability: You do what you say you’re going to do.
- Advocacy: You fight for the best possible outcome for providers and their patients.
- Clarity: You make it all understandable.
- 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.
- Strong organizational skills with the ability to manage multiple priorities effectively.
- 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.