Director, Clinical Documentation Improvement

Job Title: Director, Clinical Documentation Improvement

Supervisor: VP, Market Operations

Required License(s)/ Certification(s): CPC (Certified Professional Coder) or CRC (Certified Risk Adjustment Coder) credential required, or equivalent coding certification. CDEO or RHIA preferred.

FLSA Status: Exempt

Summary:The Director, Clinical Documentation Improvement is responsible for leading Apex Health Solutions’ risk adjustment and clinical documentation improvement (CDI) strategy across employed and contracted provider engagements. This role owns end-to-end CDI workflow design—from EMR-embedded and portal-driven programs to payer relationship support and compliance oversight. The Director manages a team of CPC-credentialed coders, drives AI-enabled and potential offshore efficiency strategies, and serves as a strategic partner to clients, payers, and internal Apex Medical and Product leadership.

This is a high-impact, client-facing leadership role requiring deep expertise in risk adjustment methodology, coding compliance, and provider education.

• Design, implement, and oversee both employed and contracted CDI workflows, including EMR-embedded and portal-driven program models.
• Ensure workflow accuracy, compliance, and scalability across diverse client environments and EMR platforms.

• Develop and execute a comprehensive risk adjustment strategy that drives accurate, specific, and compliant clinical documentation across client provider networks.
• Lead workflow development for new client onboardings per year, customizing approaches by EMR platform and client operating model.
• Serve as a client-facing leader, delivering weekly and monthly performance reporting and strategic presentations in partnership with Market Operations leadership.

• Recruit, lead, and develop a team of CPC-credentialed coders supporting both embedded and contracted CDI workflows.
• Scale and optimize the staffing model to meet client growth, including evaluation of AI-assisted coding tools and offshore hiring strategies to drive efficiency.
• Conduct performance management, annual reviews, and ongoing coaching to develop team capabilities and maintain coding quality standards.

• Serve as a subject matter expert and internal advocate for CDI workflow enhancements, translating operational insights into actionable product requirements.
• Partner with key external consultants to develop the data and AI layers supporting coding workflows, including predictive risk capture and documentation gap identification tools.
• Inform the design and development of audit workflow capabilities to support compliance, accuracy, and revenue integrity.

• Develop and maintain a comprehensive provider education library covering risk adjustment best practices, HCC coding, and documentation specificity.
• Partner with Apex Medical leadership to align provider education strategies with clinical quality and risk adjustment objectives.
• Design continuing medical education (CME) offerings that drive provider engagement and support CME credit attainment.
• Develop and oversee the provider audit workflow to identify documentation gaps, track remediation, and measure improvement over time.

• Support the development and management of upstream payer relationships, including national payers such as United Healthcare, Humana, and others specific to risk adjustment scope.
• Oversee risk adjustment reporting deliverables required by contracted payers, ensuring accuracy, timeliness, and compliance.
• Lead Annual Supplemental Mapping (ASM) process development and support payer-facing risk adjustment submissions and reconciliation activities.

• Establish and maintain a robust compliance framework for all risk adjustment activities, ensuring alignment with CMS guidelines, RADV audit standards, and payer contract requirements.
• Oversee internal audit processes to monitor…