CenterWell
Medical Coding Director - East and West
CenterWell, Charlotte, North Carolina, United States, 28245
Become a part of our caring community and help us put health first
The Director, Medical Coding extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. The Director, Medical Coding requires an in-depth understanding of how organization capabilities interrelate across the function or segment.
Strategy:
In partnership with AVP, Risk Adjustment and AVP, MRA Strategy, responsible for driving ongoing efficiency and effectiveness of the divisional teams through use of people, processes, and technology enablement (including GenAI).
Responsible for performance management and strategy development for PCO risk adjustment at the division and market level; Partners with Clinical Documentation Improvement, Audit, and Education to develop programs to improve clinical documentation.
Partner with MRA Strategy and Analytics teams to establish risk adjustment analytics to identify coding improvement opportunities, provider coding improvement opportunities, risk score trending and tracking.
Partners with MRA Strategy Leader to identify and influence enhancements to the GenAI (C.O.D.E.R) tool to improve the medical coder experience.
Oversees coding operations by identifying Dyad partner needs and developing solutions.
Responsible for overall performance of onshore and offshore coding teams.
Dyad Partnership/Influence:
Collaborates with analytical resources to develop, communicate, and present analyses of KPIs for the division, individual markets, and clinics to determine areas of opportunity.
Partner with Dyad leaders to develop and implement improvement programs at the clinic, market, and provider level.
Proactively communicate performance, opportunities, and risks to Dyad Partners.
Partners with Divisional CMO to support special projects (i.e., Accelr8- EDAPS improvement initiative).
Identify/share best practices within the markets and division to foster consistent, compliant process flows.
Partner with Analytics teams to address data outages and communicate remediation plan to Dyad partners.
Partners with market operational leaders to identify operational issues that impact clinician and coder performance.
Develops strategic partnership with the Clinical Documentation Improvement (CDI) Physician Liaison to lead clinical documentation improvement efforts.
Facilitate meetings with key partners, including Clinical, Operations, Analytics, EMR, etc. to address concerns and resolve issues.
Partner with Dyad leaders to ensure smooth integration of newly acquired acquisitions.
Productivity and Quality Management:
Establish Key Performance Indicators (KPIs) for coding productivity and accuracy (90% coder accuracy).
Monitor coding staff workload and redistribute resources as needed to meet market operational demands.
Monitor coding processes, identify inefficiency, and develop recommendations for improvement.
Partner with Operational Excellence team to identify process enhancements and streamline workflows as needed.
Strategic partner with offshore coding team and leaders to address post-visit review coding KPIs.
Participate in payor meetings/discussions to ensure accurate data submission.
Coder Education:
Based on coder audits and in partnership with the training organization, develop comprehensive training program for coding staff.
Partner with analytics and audit to identify coder errors and develop plans to address deficiencies.
Associate Engagement and Retention:
Develop and implement strategies to foster a positive work environment that encourages collaboration, innovation, and personal growth.
Conduct regular feedback sessions, performance evaluations and career development discussions with coding staff.
Assess employee concerns, resolve conflicts, and create initiatives to improve satisfaction and retention.
Use your skills to make an impact
Required Qualifications:
10 or more years of Medical Coding or similar experience.
Medical Coding Certification.
Minimum 5 years of management experience.
Ability to travel.
Preferred Qualifications:
Bachelor’s degree in business, healthcare administration, or related field.
Proven experience with Medicare Advantage risk adjustment functions.
Proven track record of working collaboratively with clinical and operational colleagues across the organization.
Knowledge, Skills, and Abilities:
Comprehensive knowledge of all Microsoft Office applications, including Word, Excel, and PowerPoint.
Ability to communicate effectively and sensitively with clinicians and team members in stressful situations.
Ability to lead by influence to engage colleagues and lead teams cross-functionally.
Experience in fostering networks with internal and external stakeholders.
Possess strong business acumen, excellent strategic thinking, and effective critical thinking skills.
Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction or guidance.
Excellent verbal and written communications skills with demonstrated ability to communicate, present, and influence both credibly and effectively at all levels of an organization.
Ability to work in a rapidly changing, matrixed environment.
Has a positive, collaborative mindset to foster partnership within and the Coding, Audit, and Education department, the PCO, and Humana.
Proven ability to independently lead complex projects requiring cross functional alignment.
Scheduled Weekly Hours:40
Pay Range:The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$112,400 - $154,900 per year.This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits:Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work.
About us:About CenterWell Senior Primary Care: CenterWell Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. Our unique care model focuses on personalized experiences, taking time to listen, learn and address the factors that impact patient well-being.
About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation’s largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients.
Equal Opportunity Employer:It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status.
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The Director, Medical Coding extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. The Director, Medical Coding requires an in-depth understanding of how organization capabilities interrelate across the function or segment.
Strategy:
In partnership with AVP, Risk Adjustment and AVP, MRA Strategy, responsible for driving ongoing efficiency and effectiveness of the divisional teams through use of people, processes, and technology enablement (including GenAI).
Responsible for performance management and strategy development for PCO risk adjustment at the division and market level; Partners with Clinical Documentation Improvement, Audit, and Education to develop programs to improve clinical documentation.
Partner with MRA Strategy and Analytics teams to establish risk adjustment analytics to identify coding improvement opportunities, provider coding improvement opportunities, risk score trending and tracking.
Partners with MRA Strategy Leader to identify and influence enhancements to the GenAI (C.O.D.E.R) tool to improve the medical coder experience.
Oversees coding operations by identifying Dyad partner needs and developing solutions.
Responsible for overall performance of onshore and offshore coding teams.
Dyad Partnership/Influence:
Collaborates with analytical resources to develop, communicate, and present analyses of KPIs for the division, individual markets, and clinics to determine areas of opportunity.
Partner with Dyad leaders to develop and implement improvement programs at the clinic, market, and provider level.
Proactively communicate performance, opportunities, and risks to Dyad Partners.
Partners with Divisional CMO to support special projects (i.e., Accelr8- EDAPS improvement initiative).
Identify/share best practices within the markets and division to foster consistent, compliant process flows.
Partner with Analytics teams to address data outages and communicate remediation plan to Dyad partners.
Partners with market operational leaders to identify operational issues that impact clinician and coder performance.
Develops strategic partnership with the Clinical Documentation Improvement (CDI) Physician Liaison to lead clinical documentation improvement efforts.
Facilitate meetings with key partners, including Clinical, Operations, Analytics, EMR, etc. to address concerns and resolve issues.
Partner with Dyad leaders to ensure smooth integration of newly acquired acquisitions.
Productivity and Quality Management:
Establish Key Performance Indicators (KPIs) for coding productivity and accuracy (90% coder accuracy).
Monitor coding staff workload and redistribute resources as needed to meet market operational demands.
Monitor coding processes, identify inefficiency, and develop recommendations for improvement.
Partner with Operational Excellence team to identify process enhancements and streamline workflows as needed.
Strategic partner with offshore coding team and leaders to address post-visit review coding KPIs.
Participate in payor meetings/discussions to ensure accurate data submission.
Coder Education:
Based on coder audits and in partnership with the training organization, develop comprehensive training program for coding staff.
Partner with analytics and audit to identify coder errors and develop plans to address deficiencies.
Associate Engagement and Retention:
Develop and implement strategies to foster a positive work environment that encourages collaboration, innovation, and personal growth.
Conduct regular feedback sessions, performance evaluations and career development discussions with coding staff.
Assess employee concerns, resolve conflicts, and create initiatives to improve satisfaction and retention.
Use your skills to make an impact
Required Qualifications:
10 or more years of Medical Coding or similar experience.
Medical Coding Certification.
Minimum 5 years of management experience.
Ability to travel.
Preferred Qualifications:
Bachelor’s degree in business, healthcare administration, or related field.
Proven experience with Medicare Advantage risk adjustment functions.
Proven track record of working collaboratively with clinical and operational colleagues across the organization.
Knowledge, Skills, and Abilities:
Comprehensive knowledge of all Microsoft Office applications, including Word, Excel, and PowerPoint.
Ability to communicate effectively and sensitively with clinicians and team members in stressful situations.
Ability to lead by influence to engage colleagues and lead teams cross-functionally.
Experience in fostering networks with internal and external stakeholders.
Possess strong business acumen, excellent strategic thinking, and effective critical thinking skills.
Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction or guidance.
Excellent verbal and written communications skills with demonstrated ability to communicate, present, and influence both credibly and effectively at all levels of an organization.
Ability to work in a rapidly changing, matrixed environment.
Has a positive, collaborative mindset to foster partnership within and the Coding, Audit, and Education department, the PCO, and Humana.
Proven ability to independently lead complex projects requiring cross functional alignment.
Scheduled Weekly Hours:40
Pay Range:The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$112,400 - $154,900 per year.This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits:Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work.
About us:About CenterWell Senior Primary Care: CenterWell Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. Our unique care model focuses on personalized experiences, taking time to listen, learn and address the factors that impact patient well-being.
About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation’s largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients.
Equal Opportunity Employer:It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status.
#J-18808-Ljbffr