Clinical Documentation Manager

This is a fully remote position, open to applicants in United States.

📋 Description

• Act as the clinical documentation integrity expert and strategic collaborator with Risk Adjustment leadership and cross-functional teams.

• Participate in the Coding Steering Workgroup to ensure compliance with ICD-10-CM, AHA Coding Clinic, CMS, and AHIMA guidelines.

• Create, standardize, and oversee clinical documentation guidelines, EHR template recommendations, and provider webinars across the network.

• Collaborate with Practice Consultants on provider interactions, JOC presentation materials, and complex coding questions.

• Assist with internal and external risk adjustment audit responses, including chart reviews and guideline-supported audit rebuttals.

• Develop AI-assisted workflows and automated tracking systems for CDI research, audit preparedness, and provider training.

• Work alongside clinical and operational leaders to enhance risk adjustment insights logic utilizing multi-source clinical data.

• Conduct medical record reviews and trend analyses to uncover documentation integrity issues and evaluate educational results.

• Operate independently as an individual contributor with no direct reports while managing personal priorities effectively.

⛳️ Requirements

• Minimum of 3 years of experience in Outpatient Clinical Documentation Integrity (CDI) or over 5 years in Medicare Advantage Risk Adjustment coding/auditing.

• Extensive subject matter knowledge in Medicare Advantage Risk Adjustment (CMS-HCC), ICD-10-CM coding standards, AHA Coding Clinic guidelines, and CMS regulations.

• Current, valid professional credential from AAPC, AHIMA, or ACDIS.

• Proven experience in conducting medical record chart reviews, assessing documentation integrity, and managing audit rebuttals.

• Strong commitment to compliance, ethical coding practices, and adherence to healthcare regulatory standards.

• Proficient in analyzing spreadsheets and dashboards, prioritizing competing deadlines, and adjusting to changing workflows.

• Excellent collaborative communication skills to articulate complex coding decisions effectively.

• Prior clinical experience or healthcare licensure (e.g., RN, LPN, NP, PA, or MD) is preferred.

• Familiarity with modern technical tools, generative AI/LLM workflows, or healthcare data analytics is preferred.

• Experience participating in workgroups, cross-functional initiatives, or continuous process improvement projects is preferred.

🏝️ Benefits

• Employer-sponsored health, dental, and vision insurance with low or no premium.

• Generous paid time off policy.

• $100 monthly stipend for mobile or internet expenses.

• Stock options available for all employees.

• Bonus eligibility for all positions, excluding Director and above.

• Parental leave program offered.

• 401K program available.

• Comprehensive rewards package for full-time employees.