Job Description

Join to apply for the Director, Medical Coding role at Conviva Senior Primary Care 1 day ago Be among the first 25 applicants Conviva Senior Primary Care provided pay range This range is provided by Conviva Senior Primary Care. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more. Base pay range $115,200.00/yr - $158,400.00/yr 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. Strategy 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 Dyad Partnership/Influence 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. Productivity And Quality Management 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. Coder Education 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. Associate Engagement And Retention Develop and implement strategies to foster a positive work environment that encourages collaboration, innovation, and personal growth. Conduct regular feedback sessions, performance evaluations and career development discussions with coding staff. Assess employee concerns, resolve conflicts, and create initiatives to improve satisfaction and retention. Required Qualifications Bachelor’s degree Minimum of 5 years of experience in program management, healthcare operations, or strategic execution roles. A minimum of five years of people leadership experience, with a track record of managing teams and driving performance. RHIA, RHIT, CCS, CPC Certification MS-DRG auditing or APR auditing experience Acute in-patient and/or outpatient coding experience Excellent communication and executive presence - able to clearly explain complex ideas and influence diverse audiences. High emotional intelligence and collaboration skills; able to connect dots across systems and teams. Preferred Qualifications Master's Degree Additional Information Preferred work hours: EST or CST Up to 20% travel nationally within CenterWell markets. Work At Home Requirements To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self‑provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested Satellite, cellular and microwave connection can be used only if approved by leadership Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi‑weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours: 40 Pay Range: $115,200 - $158,400 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description Of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole‑person well‑being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short‑term and long‑term disability, life insurance and many other opportunities. About Us Conviva Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. As part of CenterWell Senior Primary Care, Conviva’s innovative, value‑based approach means each patient gets the best care, when needed most, and for the lowest cost. We go beyond physical health – addressing the social, emotional, behavioral and financial needs that can impact our patients' well‑being. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. #J-18808-Ljbffr Conviva Senior Primary Care

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