Manager Coding & Documentation Analysis

CareBridge Health is a proud member of the Elevance Health family of companies, within our Carelon business. CareBridge Health exists to enable individuals in home and community-based settings to maximize their health, independence, and quality of life through homecare and community-based services.

Location:

Requires 3 days per week in the office. You must be within a reasonable commute of one of our eligible offices.

Hours:

General business hours, Monday through Friday. (Core hours: 8-5)

Hybrid 2:

This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office.

Responsible for leading coding team operations to drive high-quality documentation of clinical encounters and ensure adherence to the latest diagnostic documentation guidelines and clinical best practices.

Primary Duties

Serves as the primary resource and subject matter expert on all Medicare and Medicaid clinical documentation.

Participates in all consultations related to coding and clinical documentation and creation of policy briefs for leadership.

Execute day-to-day coding operations and ensure high-quality coding of diagnoses against ICD-10 and CPT classification systems.

Drives high performance on coding team KPIs (e.g., turnaround times, claim denial rate due to technical issues, secondary review scores).

Develop and iterate team workflows, KPIs, and associated reporting to meet quarterly goals for coding timeliness and quality.

Maintains high performance through operational efficiency and ongoing business optimization.

Develops and implements strategy for quality reviews of coder performance and associated coaching.

Implements clear details on percentage of encounters reviewed, rubrics based on latest Medicare and State Medicaid guidelines, translation of review findings into frontline coaching, and criteria for coder performance management.

Required Qualifications

Requires a BA/BS and minimum 5 years coding leadership experience, or any combination of education and experience which would provide an equivalent background.

Experience with various Risk Models including CMS.is required.

Experience with regulations relating to Medicare, Medicaid, and commercial insurance providers is required.

Preferred Qualifications

Certified Medical Coder (CPC or CCS-P) is a must for this role!

CPMA (Certified Professional Medical Auditor) and/or CRC (Certified Risk Adjustment Coder) certification preferred.

Strong analytical skills, including experience conducting exploratory analyses in Microsoft Excel is preferred (bonus if SQL-savvy).

We offer a range of market-competitive total rewards that include merit increases, paid holidays, paid time off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k)+match, stock purchase plan, life insurance, wellness programs, and financial education resources.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender, marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, and local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 Florida Agency for Health Care Administration.

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