Clinical Coding Services Manager

Summary

Join Reveleer, a leading value-based care technology platform, as a Clinical Coding Manager to oversee risk adjustment and reporting. You will perform accurate medical record reviews, support quality improvement initiatives, conduct training, and monitor project status. The role involves managing coding projects, reviewing positive/negative hits, and working on flexible projects with varying guidelines. You will analyze medical records, validate clinical evidence, ensure accurate code assignment, and maintain patient data confidentiality. Success requires strong analytical, communication, and problem-solving skills, along with a commitment to continuous quality improvement and customer focus.

Requirements

• Must have a professional coding certificate through AHIMA/AAPC
• Minimum of 5 years of hands-on medical records experience
• 5 Years of RISK experience
• Strong computer skills and high-speed internet access at home
• Commitment to confidentiality of patient health information
• Professional, articulate and able to work independently
• Ability to manage teams and meet deadlines
• Be able to conduct trainings in nonstandard time frames to meet abstractor needs and training

Responsibilities

• Oversee and/or perform an accurate medical record review for all RISK
• Support and participate in process and quality improvement initiatives
• Conduct training related to ,RISK, platform usage, up date any training materials, and function as RISK SME
• Monitor project status
• Work on flexible projects with variable client/project specific guidelines
• Review all Negative / Positive hits
• Manage RISK coding projects when needed- including project status and completing chart reviews for coding projects as needed
• Clinical Documentation Review: Analyze medical records and NLP results and validate that the clinical evidence meets the necessary requirements for submission and documentation. This includes making sure the documentation accurately reflects the patient’s conditions, treatment and services provided. Identify gaps, inconsistencies, and discrepancies in documentation that could impact patient care, quality reporting and reimbursement
• Coding Support: Ensure documentation aligns with accurate code assignment and follow CMS’s coding guidelines for HCC risk adjustment coding
• Clinical Knowledge: Maintain a deep understanding of medical terminology, disease processes, treatments, and procedures to accurately interpret and validate clinical documentation
• Documentation Integrity: Safeguard the integrity and confidentiality of patient health information while handling medical records and sensitive data in accordance with HIPAA and other relevant regulations
• Interdisciplinary Communication: Foster clear communication and collaboration between different healthcare departments, ensuring that accurate patient information is shared across the continuum

Preferred Qualifications

Background in UR, QA and/or QI experience preferred

Benefits

SALARY RANGE: $80,000 - $90,000 / annually