Manager, Clinical Documentation Integrity – CDI

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 times.

• Monitor work queues and workflows, identifying any bottlenecks that may arise.

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

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

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

• Take ownership of onboarding processes, training plans, reference materials, workflows, and readiness audits for new CDI specialists.

• Guide team members in technical knowledge, quality, productivity, and their professional development.

• Track metrics related to accuracy, quality, production, turnaround time, and other CDI indicators.

• 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 guidelines.

• Work in partnership with physician leadership, clinical teams, Medical Records, retrieval, billing, claims, and other operational departments.

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

• Support audit preparedness, including RADV and other regulatory or payer reviews.

• Report directly to the Director of Clinical Documentation Integrity.

⛳️ 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 while holding them accountable to defined performance standards.

• Extensive knowledge of ICD-10-CM and CMS-HCC risk-adjustment methodologies, including V24 and V28.

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

• Possession of an 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 platforms related to CDI, coding, or risk adjustment.

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

• CRC certification is advantageous; CDIP or CCDS certifications are also considered beneficial.

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

• Capability to coach technical teams without resorting to micromanagement.

• Proficiency in utilizing data and performance metrics to identify issues and drive improvements.

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

• Aptitude for working in a structured, deadline-driven environment where attention to detail is crucial.

• Demonstrated judgment and discretion in managing sensitive performance and compliance issues.

🏝️ Benefits

• Competitive annual performance bonus (including commission where applicable).

• Comprehensive health, dental, and vision insurance.

• Paid time off to ensure work-life balance.

• 401(k) plan with company matching contributions.

• Opportunities for skill development and taking on new challenges.

• Reasonable accommodations provided during the recruitment process.