Manager, Coding Quality – RADV Audits

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

📋 Description

• Provide strategic direction, planning, project coordination, and operational management for CMS-mandated RADV audits across Medicare Advantage and Commercial business lines.

• Develop and execute audit strategies, workflows, processes, and performance goals.

• Set priorities and balance departmental workloads to enhance productivity, quality, efficiency, and resource utilization.

• Oversee departmental operations, including planning, problem-solving, staff development, performance management, and organizational communication.

• Convert business and regulatory requirements into actionable objectives and measurable results.

• Identify opportunities for process improvement and operational efficiency, implementing sustainable solutions.

• Provide executive-level and cross-functional leadership for strategic initiatives and regulatory activities.

• Lead special projects, initiatives, and complex problem-solving efforts.

• Monitor departmental performance, identify trends and risks, and implement corrective measures.

• Cultivate partnerships across business, clinical, compliance, technology, and operational teams.

• Ensure departmental activities comply with CMS regulations, company policies, contractual obligations, and industry standards.

• Supervise both exempt and non-exempt staff.

• Interview, select, hire, onboard, and train new employees.

• Plan, assign, prioritize, and direct work activities.

• Set performance expectations and conduct evaluations.

• Mentor, develop, recognize, and counsel employees.

• Support enhancements in quality coding reporting.

• Address employee concerns and resolve workplace issues.

• Manage staffing levels, resource distribution, and departmental capacity.

• Develop and interpret policies and procedures, recommending changes to senior management.

⛳️ Requirements

• Bachelor's degree preferred; candidates with a clinical license and substantial relevant experience may be considered in place of a degree.

• Required coding certification: CPC, COC, or CRC from AAPC, or CCS or CCS-P from AHIMA.

• At least 7 years of experience in risk adjustment programs.

• Minimum of 3 years of management experience in a medical coding quality assurance environment, demonstrating technical expertise.

• Experience in the healthcare payer industry, including health plans, third-party administrators, benefits consulting, or healthcare technology organizations.

• Proven track record of leading complex, enterprise-level projects, programs, or regulatory initiatives.

• Knowledge and practical experience with CMS regulations and requirements.

• Proficiency in Microsoft Word, Excel, and PowerPoint is required.

• Experience with Microsoft Project is preferred.

• Familiarity with JIRA or similar project management tools is preferred.

• Ability to work across multiple time zones in a hybrid or remote work setting.

• May be required to pass a pre-employment criminal background check.

• Must meet physical demands, including extended periods of sitting and/or standing at a computer.

🏝️ Benefits

• Commitment to ongoing professional development and learning opportunities.

• Support for professional development and continuous learning.

• Reasonable accommodations for individuals with disabilities.

• Potential travel based on company needs.