Manager, Clinical Documentation Integrity

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

📋 Description

• Oversee the daily operations of both prospective and concurrent CDI review processes.

• Establish and uphold standards for quality, productivity, and turnaround time.

• Supervise work queues and workflow to identify any bottlenecks.

• Facilitate team huddles, one-on-ones, coaching sessions, and performance evaluations.

• Manage scheduling, coverage, timecards, and requests for time off.

• Act as the primary point of escalation for coding inquiries and obstacles.

• Take charge of onboarding, training plans, resources, workflows, and readiness assessments for new CDI specialists.

• Mentor team members in technical expertise, quality, productivity, and their professional development.

• Monitor accuracy, quality, production, turnaround time, and other CDI-related metrics.

• Detect trends, root causes, and opportunities for improvement.

• Collaborate on audits, scoring methodologies, follow-up reviews, and quality enhancement initiatives.

• Develop and refine SOPs, workflows, job aids, documentation standards, coding best practices, and internal guidance.

• Work alongside physician leadership, clinical teams, Medical Records, retrieval, billing, claims, and operational teams.

• Convert complex coding and documentation requirements into actionable guidance.

• Ensure compliance with ICD-10-CM guidelines, CMS-HCC risk-adjustment requirements, payer policies, and relevant regulations.

• Assist in maintaining audit readiness, including RADV and other regulatory or payer reviews.

⛳️ Requirements

• A minimum of 5 years of experience in clinical documentation integrity, risk adjustment, or HCC coding, particularly with Medicare Advantage populations.

• Proven experience in leading, coaching, or supervising teams and holding them accountable for clear performance expectations.

• In-depth knowledge of ICD-10-CM and CMS-HCC risk-adjustment methodologies, particularly V24 and V28.

• Extensive experience collaborating with physicians and clinical teams to enhance documentation quality.

• Active coding credential such as CRC, CPC, CCS, RHIT, or RHIA.

• An Associate's or Bachelor's degree in Health Information Management, nursing, or a related field, or equivalent relevant experience.

• Familiarity with EHRs and CDI, coding, or risk-adjustment platforms.

• Strong judgment skills in navigating complex compliance, quality, and performance issues.

• CRC certification is preferred, with CDIP or CCDS being a valuable addition.

• Experience in developing training programs, provider education, SOPs, or workflows.

• Capability to coach technical teams effectively without micromanagement.

• Proficient in using data and performance metrics to identify issues and drive improvements.

• Ability to clearly articulate complex coding and documentation requirements to coders, physicians, and non-technical stakeholders.

• Strong sense of ownership and problem-solving skills.

• Capacity to excel in a structured, deadline-oriented environment where attention to detail is crucial.

• A collaborative and supportive leadership approach.

• Discretion and judgment in handling sensitive performance and compliance matters.

🏝️ Benefits

• Generous annual performance bonus (including commission if applicable).

• Health, dental, and vision insurance.

• Paid time off.

• 401(k) plan with company matching contributions.

• Opportunities for skill enhancement and new challenges.

• Reasonable accommodations provided throughout the recruitment process.