CDI Lead

Summary

Join Aledade as a CDI/Quality Assurance Lead to support documentation improvement and coding efforts for practices in value-based contracts. This remote U.S.-based role, with occasional travel, is crucial for ensuring high-quality care and regulatory compliance for Medicare beneficiaries. You will lead the development and implementation of quality assurance programs, monitor program effectiveness, and identify areas for improvement. The ideal candidate possesses strong analytical, organizational, and communication skills, along with expertise in QA tools and healthcare regulations. A service-oriented mindset and proficiency in Google Suite are essential. Passion for Aledade's physician-led ACO model is a plus.

Requirements

• Bachelor's degree in Health Information Management or related healthcare field
• 10 years of experience in lieu of the degree
• Minimum 5 years of experience in a health plan or health system setting
• Minimum of 2 years of experience in Risk Adjustment
• Previous experience in a quality assurance program and extensive knowledge of state and federal regulations and guidelines pertaining to documentation and coding
• Thorough understanding of medical coding guidelines and regulations including compliance, reimbursement, and the impact of diagnosis documentation on risk adjustment payment models

Responsibilities

• Plan, develop, implement, and manage quality assurance programs across the organization’s coding, billing and CDI (Clinical Documentation Improvement) functions
• Oversee and monitor the effectiveness of the QA program, ensuring compliance and high performance; develop key performance indicators (KPIs) to assess quality and identify areas for process improvements; and implement process improvement strategies necessary to meet annual targets
• Identify high risk areas and plan, monitoring activities to evaluate compliance with laws, regulations, policy and procedures, and coding and billing standards
• Create and implement standardized audit monitoring methodology
• Ensure standard operating procedures (SOPs) and clinical templates are compliant with current applicable regulations, laws and guidance
• Serve as a liaison and subject matter expert on regulatory compliance, clinical documentation, coding, and billing for both internal and external customers

Preferred Qualifications

• Active nursing credential as Registered Nurse (RN) or international MD
• Minimum of 4+ years of management experience
• Complete understanding of acuity levels for specific patient populations and strong clinical knowledge with the ability to interpret clinical documentation. Experience working directly with physician practices and individual providers to achieve demonstrable improvement of the accuracy and completeness of documentation and coding
• Subject matter expertise on the Risk Adjustment program, methodology, and impact to value-based contracts across multiple lines of business (Medicare, Medicaid, & Commercial)
• Master’s degree in health related fields
• RHIA – Registered Health Information Administrator (RHIA) - AHIMA
• RHIT – Registered Health Information Technician (RHIT) - AHIMA
• Certified Coding Specialist (CCS) - AHIMA
• Certified Documentation Improvement Practitioner (CDIP) – AHIMA
• Certified Clinical Documentation and Certification - Outpatient (CCDS-O) - ACDIS
• Certified Risk Coder (CRC) - AAPC
• Certified Professional Medical Auditor (CPMA) - AAPC
• Certified Professional Biller (CPB) - AAPC
• Rural Health Coding & Billing Specialist (RH-CBS) - ArchPro Coding
• Community Health Coding & Billing Specialist (CH-CBS) - ArchPro Coding

Benefits

• Salary Range: $91,000-$101,000 base + bonus + equity
• Remote position based in the U.S., with periodic travel to Aledade’s headquarters in Bethesda, MD, and assigned markets