Director, Medical Coding

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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.

• 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 (includes coordination with Consultative Coding leaders/coders)
• 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

• Collaborates with analytical resources to develop, communicate, and present analyses of KPIs for the division, individual markets, and clinics to determine areas of opportunity (unlocked notes, pending addendums, etc. Presents analyses to Dyad leaders monthly.
• Partner with Dyad leaders to develop and implement improvement programs and the clinic, market, and provider level; includes monitoring and refinement of existing programs and strategies to identify opportunities for improvement.
• Proactively communicate performance, opportunities, and risks to Dyad Partners
• Partners with Divisional CMO to support special projects (i.e., Accelr8- EDAPS improvement initiative). Includes development of action plans in partnership with Area Medical Directors and Regional Chief Medical Officers.
• 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. (Problem List Hygiene)
• Develops strategic partnership with the Clinical Documentation Improvement (CDI) Physician Liaison to lead clinical documentation improvement efforts; manages the divisional CDI specialist.
• 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.

• 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 (quality, Turn-Around-TAT, appropriate clinician queries).
• Participate in payor meetings/discussions to ensure accurate data submission.

• Based on coder audits and in partnership with the training organization, develop comprehensive training program for coding staff to ensure continuous skill development and compliance with coding standards.
• Partner with analytics and audit to identify coder errors and develop plans to address deficiencies/specific areas of focus.

• Develop and implement strategies to foster a positive work environment that encourages…