Manager Clinical Performance & Quality Coding (Nurse Practitioner or PA)

Manager Clinical Performance & Quality Coding LOCATION : The position requires that you be in the office 3x per week. You must be within a commutable distance of one of our eligible offices. HOURS : General business hours, Monday through Friday (8-5 central) Hybrid 2: This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law. Responsible for leading the quality documentation and value capture for all provider visit medical encounters to ensure application of accurate diagnosis codes (ICD-10 codes). Primary duties include but not limited to : Serves as the primary resource and subject matter expert on all CMS Risk Adjustment and quality documentation. Develop and deliver clinical focused training on advance coding and documentation while incorporating coder feedback. Liaison to the clinical leadership on alignment of goals and workflows to support value capture initiatives and high-quality clinical documentation. Develop performance management plan, KPI's and clinical level tracking to meet quarterly goals for coding timeliness, accuracy, and Risk Adjustment. Develop and manage clinical quality reviews to ensure peer review and clinical quality chart audit process including targeting chart reviews, auditing percentages, score guidelines feedback mechanism and ensure compliance with remediation procedures. Develop operational and clinical workflows for closing HEDIS care opportunities to ensure practices and health plan success. Participate in peer review of medical documentation for completed visits notes as well as patient profile information in EMR. Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Requires a current, active, valid, and unrestricted nurse practitioner (NP) or physician assistant (PA) license from the state in which you reside. Requires a master's in Nursing (or PA equivalent) and at least 3 years of clinical experience in applying appropriate diagnosis in the Medicare HCC Mode; or any combination of education and experience, which would provide an equivalent background. Requires experience with CMS Risk Models.

You must have previous management/supervisory experience with direct reports. HEDIS experience is preferred. Experience with clinical data/documentation integrity is preferred (CDEO or CDEI). Prefer AAPC Certified Risk Adjustment Coder (CRC) certification. Job Level: Manager Workshift: Job Family: MED > Licensed Nurse Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and