Manager, Coding & Documentation Improvement
Pediatric Associates, San Antonio, Texas, United States, 78208
Manager, Coding & Documentation Improvement
Location: Plantation, FL
Facility: Corporate - Enterprise Allocations
Schedule: Shift, Hours: Full Time, Days
The Coding and Documentation Improvement Manager will lead initiatives across Clinical Documentation Integrity (CDI), coding accuracy, and provider education to drive excellence in documentation, billing compliance, and performance-based coding metrics. This role will develop and deploy strategies that align with value-based care, risk adjustment models, and payer-specific regulations, ensuring Pediatric Associates meets both internal performance standards and external regulatory requirements.
ESSENTIAL DUTIES AND RESPONSIBILITIES This list may not include all of the duties that may be assigned.
Clinical Documentation & Coding Optimization
Lead initiatives to improve diagnosis capture, focusing on secondary and chronic conditions and supporting value-based care models.
Direct SDOH education programs and develop audit tools to measure SDOH coding performance.
Oversee development of documentation improvement workflows integrated into EHR, including prompts and real-time query tools.
Champion the implementation of coding best practices and standardize workflows across physician groups.
Deliver performance dashboards to providers, highlighting missed coding opportunities and areas for improvement.
Provider & Staff Education
Develop ongoing educational curriculums for providers, coders, and clinical staff.
Launch targeted training for physicians on supplemental billing codes including lab screenings, nutrition/diabetes education, and behavioral health screenings.
Deliver performance dashboards to providers, highlighting missed coding opportunities and areas for improvement.
Audit & Accuracy Oversight
Design and implement a structured coding audit program with quarterly audit/re‑audit cadence.
Define measurable accuracy goals (target: 95%+) and track progress through real‑time analytics.
Analyze audit results to identify root causes of errors and develop corresponding training plans.
Build a team skill matrix and conduct quarterly skills assessments to ensure readiness in addressing coding‑related denials.
Collaborate with denial management teams to identify coding trends and proactively correct system and knowledge gaps.
Align coding accuracy improvement with reduction in denial rates and rework.
Technology & Innovation
Partner with IT and EHR vendors to develop smart prompts, SDOH flags, and query triggers embedded within clinical workflows.
Drive automation for coding feedback loops and predictive reporting for high‑risk denial categories.
Leadership & Governance
Lead, mentor, and evaluate a high‑performing team; ensure consistency in remote and on‑site operations.
Develop monthly reporting dashboards for coding accuracy, SDOH capture, diagnosis completeness, and denial trends.
Present performance metrics and improvement roadmaps to executive leadership.
SUPERVISORY RESPONSIBILITIES
This role will have direct supervisory responsibility for three Physician Educators initially, with plans to expand the team over time.
In addition, Coders will have a dotted‑line reporting relationship to this position.
QUALIFICATIONS
Education: Bachelor’s or Associate’s degree in Health Information Management, Nursing, or related field preferred.
Experience: A minimum of 5 years in coding and/or revenue cycle or related roles, preferably in pediatric or multi‑specialty settings. Experience with payer‑specific programs (e.g., Medi‑Cal), risk adjustment models, and value‑based care preferred.
Licensure / Certification: RHIA, RHIT, CCS, or CDIP certification required.
KNOWLEDGE, SKILLS AND ABILITIES
Demonstrate success in implementing education programs and potential coders will have a dotted line.
TYPICAL WORKING CONDITIONS
May be full time remote/telework OR May rotate working in the office and remote/telework.
This job must be U.S. based.
Operating Computer.
Lift/Carry 10lbs. or less.
Push/Pull 12lbs. or less.
OTHER PHYSICAL REQUIREMENTS
Vision.
Sense of sound.
Sense of touch.
Ability to wear Personal Protective Equipment (PPE).
PERFORMANCE REQUIREMENTS Enter any additional requirements.
Adhere to all organizational information security policies and protect all sensitive information including but not limited to ePHI and PHI (Protected Health Information) in accordance with organizational policy, Federal, State, and local regulations.
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Location: Plantation, FL
Facility: Corporate - Enterprise Allocations
Schedule: Shift, Hours: Full Time, Days
The Coding and Documentation Improvement Manager will lead initiatives across Clinical Documentation Integrity (CDI), coding accuracy, and provider education to drive excellence in documentation, billing compliance, and performance-based coding metrics. This role will develop and deploy strategies that align with value-based care, risk adjustment models, and payer-specific regulations, ensuring Pediatric Associates meets both internal performance standards and external regulatory requirements.
ESSENTIAL DUTIES AND RESPONSIBILITIES This list may not include all of the duties that may be assigned.
Clinical Documentation & Coding Optimization
Lead initiatives to improve diagnosis capture, focusing on secondary and chronic conditions and supporting value-based care models.
Direct SDOH education programs and develop audit tools to measure SDOH coding performance.
Oversee development of documentation improvement workflows integrated into EHR, including prompts and real-time query tools.
Champion the implementation of coding best practices and standardize workflows across physician groups.
Deliver performance dashboards to providers, highlighting missed coding opportunities and areas for improvement.
Provider & Staff Education
Develop ongoing educational curriculums for providers, coders, and clinical staff.
Launch targeted training for physicians on supplemental billing codes including lab screenings, nutrition/diabetes education, and behavioral health screenings.
Deliver performance dashboards to providers, highlighting missed coding opportunities and areas for improvement.
Audit & Accuracy Oversight
Design and implement a structured coding audit program with quarterly audit/re‑audit cadence.
Define measurable accuracy goals (target: 95%+) and track progress through real‑time analytics.
Analyze audit results to identify root causes of errors and develop corresponding training plans.
Build a team skill matrix and conduct quarterly skills assessments to ensure readiness in addressing coding‑related denials.
Collaborate with denial management teams to identify coding trends and proactively correct system and knowledge gaps.
Align coding accuracy improvement with reduction in denial rates and rework.
Technology & Innovation
Partner with IT and EHR vendors to develop smart prompts, SDOH flags, and query triggers embedded within clinical workflows.
Drive automation for coding feedback loops and predictive reporting for high‑risk denial categories.
Leadership & Governance
Lead, mentor, and evaluate a high‑performing team; ensure consistency in remote and on‑site operations.
Develop monthly reporting dashboards for coding accuracy, SDOH capture, diagnosis completeness, and denial trends.
Present performance metrics and improvement roadmaps to executive leadership.
SUPERVISORY RESPONSIBILITIES
This role will have direct supervisory responsibility for three Physician Educators initially, with plans to expand the team over time.
In addition, Coders will have a dotted‑line reporting relationship to this position.
QUALIFICATIONS
Education: Bachelor’s or Associate’s degree in Health Information Management, Nursing, or related field preferred.
Experience: A minimum of 5 years in coding and/or revenue cycle or related roles, preferably in pediatric or multi‑specialty settings. Experience with payer‑specific programs (e.g., Medi‑Cal), risk adjustment models, and value‑based care preferred.
Licensure / Certification: RHIA, RHIT, CCS, or CDIP certification required.
KNOWLEDGE, SKILLS AND ABILITIES
Demonstrate success in implementing education programs and potential coders will have a dotted line.
TYPICAL WORKING CONDITIONS
May be full time remote/telework OR May rotate working in the office and remote/telework.
This job must be U.S. based.
Operating Computer.
Lift/Carry 10lbs. or less.
Push/Pull 12lbs. or less.
OTHER PHYSICAL REQUIREMENTS
Vision.
Sense of sound.
Sense of touch.
Ability to wear Personal Protective Equipment (PPE).
PERFORMANCE REQUIREMENTS Enter any additional requirements.
Adhere to all organizational information security policies and protect all sensitive information including but not limited to ePHI and PHI (Protected Health Information) in accordance with organizational policy, Federal, State, and local regulations.
#J-18808-Ljbffr