Job Description
A bit about this role:
As a Clinical Documentation Manager, you will serve as a subject matter expert within our Provider support team and the broader Risk Adjustment department, driving clinical documentation integrity and ICD-10-CM coding accuracy across the enterprise. You will be part of the Clinical Documentation Integrity hub, which owns provider education materials, documentation guidance, and answers to questions escalated from the field. Practice Consultants are your peers who also report to the Director, Risk Adjustment Provider Program. While they own provider relationships in their markets, you will support them through programs that improve risk score accuracy via practice workflow improvements and clinical documentation education. This work is largely enabling our provider network support team rather than managing a dedicated portfolio of practices.
This role also acts as a thought partner to leadership, supporting coding guidelines development, serving as a risk adjustment coding expert on internal and external audits, designing and iterating on reporting, and using technology to scale our impact. During peak audit seasons, a high percentage of your time is spent supporting our response to external audits. This is an individual contributor role with no direct reports, meaning you will work independently, manage your own priorities, and step in directly where needed.
Your Responsibilities and Impact will include:
Lead CDI & Coding Thought Partnership: Serve as the CDI subject matter expert and strategic partner to Risk Adjustment leadership and cross-functional teams, contributing to the Coding Steering Workgroup and ensuring enterprise alignment with ICD-10-CM guidelines, AHA Coding Clinic, CMS guidance, and AHIMA guidance.
Own Provider Documentation & Education Assets: Design, standardize, and maintain condition-specific clinical documentation guidance, EHR template recommendations, and network-wide webinars that drive coding accuracy and provider compliance.
Enable Field Teams & Provider Relationships: Partner closely with Practice Consultants on provider engagements, Joint Operations Committee (JOC) presentation content, and escalated coding inquiries to improve practice workflows and risk score accuracy.
Drive Audit Readiness & Response: Support external and internal risk adjustment audit responses; execute end-to-end chart evaluations and author guideline-backed audit rebuttals.
Integrate Advanced Technology & AI Solutions: Pioneer and implement emerging technologies—including AI-assisted workflows and automated tracking mechanisms—to scale CDI research, audit readiness, and provider education impact.
Develop Clinical Logic & Program Strategy: Collaborate with clinical and operational leaders in workgroups to refine and test risk adjustment insights logic using multi-source clinical data to support embedding high quality information in provider workflows.
Conduct Quality Reviews & Trend Analysis: Perform medical record reviews as needed and leverage data-driven trend analyses to identify documentation integrity findings, measure educational outcomes, and support ongoing quality assurance.
Required skills and experience :
3+ years of experience in Outpatient Clinical Documentation Integrity (CDI) or 5+ years in Medicare Advantage Risk Adjustment coding/auditing.
Deep subject matter expertise in Medicare Advantage Risk Adjustment (CMS-HCC), ICD-10-CM coding guidelines, AHA Coding Clinic guidance, and CMS regulations.
Current, active professional credential through AAPC, AHIMA, or ACDIS.
Experience conducting medical record chart reviews, evaluating documentation integrity, and executing audit rebuttals.
Demonstrated commitment to compliance, ethical coding rigor, and adhering to both the letter and spirit of healthcare regulatory standards.
Autonomous self-starter with the ability to analyze spreadsheets and dashboards, prioritize competing internal deadlines, and adapt smoothly to evolving…