Director, Medical Coding And Audit

Summary

Join CodaMetrix as the Director, Medical Coding & Audit, leading a team of certified medical coders and managing outsourced vendors. You will oversee model quality, production coding, and machine learning model performance. Responsibilities include team leadership, vendor management, auditing, ML model support, process optimization, data analysis, performance metric development, regulatory compliance, and cross-team collaboration. The ideal candidate possesses 5+ years of medical coding experience, including team management and vendor oversight, along with expertise in auditing and data analysis. CodaMetrix offers a comprehensive benefits package including health insurance, retirement plan, generous PTO, professional development opportunities, and employer-paid life and disability insurance.

Requirements

• Required Minimum of 5+ years of experience in medical coding, including team management and vendor oversight
• Proven expertise in auditing coding processes and ensuring high accuracy, particularly in a production environment
• Strong understanding of data analysis tools and their application in monitoring both team performance and machine learning model effectiveness
• Strong people management and leadership skills with a focus on mentoring and developing talent
• Excellent communication skills and the ability to effectively collaborate with cross-functional teams, including data science, engineering, and clinical informatics

Responsibilities

• Lead, mentor, and manage a team of certified medical coders who will focus on coding visits to an ideal coding level for machine learning model training and auditing
• Oversee outsourced coding vendors, ensuring their outputs align with internal standards for both coding accuracy and machine learning model improvement
• Conduct thorough audits of production coding to maintain accuracy, ensure compliance, and monitor machine learning model performance
• Collaborate with AI&ML and Engineering teams to ensure coders annotate cases appropriately to enhance the training and optimization of machine learning models
• Continuously refine and streamline coding processes to improve productivity, accuracy, and machine learning performance
• Direct coding efforts across multiple specialties, including Radiology, Pathology, Surgery, Endoscopy, Bedside Visits, Emergency Department (ED), Cardiology, and Hierarchical Condition Categories (HCC), to support the automation and prediction capabilities of our ML models
• Utilize data analysis tools to monitor team performance and coding quality, generating insights that drive process improvements and model effectiveness
• Develop and implement performance metrics for both human coders and machine learning models, ensuring the team meets goals related to accuracy, productivity, and compliance
• Stay current with industry regulations, coding standards (ICD, CPT, HCPCS), and compliance requirements, ensuring your team adheres to these standards. Define CMX way and advocate with our customers on best practices
• Cultivate strong peer relationships to continue the advancement of coding quality standards across the organization

Preferred Qualifications

• Familiarity with machine learning model training, data annotation, and the role of coders in enhancing model performance
• In-depth knowledge of coding standards (ICD, CPT, HCPCS) and experience in relevant specialties such as Radiology, Pathology, Surgery, Endoscopy, Bedside Visits, ED, Cardiology, HCC, DRG and facility coding
• Experience in process optimization, efficiency improvements, and driving performance within medical coding teams
• Certification in medical coding (e.g., CPC, CCS)

Benefits

• We cover 80% of the cost of medical and dental insurance and offer vision insurance
• We offer a 401(k) plan that eligible employees can contribute to one month after their first day
• We have a generous Paid Time Off policy, which is managed but not limited, so you can take the time you need to relax and rejuvenate
• All new hires complete our 7-week Onboarding Program where they learn about our company and each of our departments through live sessions hosted by a variety of our leaders
• We provide annual performance evaluations and prioritize working with employees on what their individual growth looks like
• We recognize the outstanding achievements of our team through annual company awards where employees have the opportunity to nominate their peers
• A modern open plan workspace located in the bustling Back Bay neighborhood of Boston
• We offer employer-paid life insurance and short-term and long-term disability insurance