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Director, Coding

Company: Landmark Health
Location: Santa Ana
Posted on: October 4, 2021

Job Description:

The Director of Coding is responsible for building, leading and optimizing the coding processes within the organization. This person will train and interact with coders, clinicians, compliance, Sr. Leadership and Executives to ensure that coding policies and procedures optimize documentation and coding accuracy and compliance. The Director of Coding must also have a strong analytical background, as this individual will be counted on to create suspected HCC diagnoses lists and identify clinical opportunities based on trends in coding data. This person should also stay up-to-date on coding regulations and best practices and be able to relay this information to the clinical team.


• Ensure that documentation and coding practices meet National practice guidelines and the compliance goals of the enterprise/organization
• Develop tools, templates, algorithms to optimize HCC Code capture, documentation, compliance
• Provide for the necessary educational programs for Coding, Clinical Documentation and ICD10
• Develop educational training materials to present to clinicians
• Assist in development of logic for suspected HCC diagnoses lists
• Oversee analysis of both market level and individual clinician performance and provide dashboard of overall performance as well as subsets by disease categories to identify areas for more intensive and focused training
• Keep up to date with changes to coding methodology / scoring and presenting back to clinical team
• Present HCC Coding Materials to physicians effectively and provide oversight and leadership of 1:1 presentations to poor performing clinicians
• Develop strategies to minimize RADV Audit
• Produce revenue projections based upon current RAF trending
• Oversee employed clinicians’ chart audit, review, and accuracy process
• Oversee any coding vendors to assure compliance and outcomes


• 3-5 years management experience in Medical Coding and Clinical Documentation
• Licensure/Certification (CCS-P, CPC, RHIA or RHIT)
• Thorough knowledge of anatomy, physiology, pharmacology and medical terminology
• Comprehensive knowledge of coding practices and official guidelines, HCPCS, ICD-9/ICD-10 and CPT, HCC (Hierarchical Condition Categories), Medicare Risk Adjustment (MRA), Healthcare Effectiveness Data and Information Set (HEDIS), as well as requirements with emphasis on Center for Medicare/Medicaid (CMS), and Office of Inspector General (OIG)
• Demonstrated auditing skills for coding quality and compliance
• Proficiency in Microsoft applications, including Outlook, Word, Excel and Power Point
• Self-starter, proactive, who works quickly and accurately and will prioritize and meet deadlines effectively
• Professional demeanor and demonstrated leadership ability; composed and effective under pressure and able to adapt to new and changing business conditions
• Strong leadership, analytical, project planning and coordination skills
• High energy; demonstrates an ability to function in a creative, entrepreneurial environment and think outside the box


We are now part of Optum and the United Health Group family of businesses, backed by the resources of a global health organization working to help people live healthier lives and to help make the health system work better for everyone.
 
As part of our hiring process, upon accepting an offer, candidates will be required to complete a 9-panel drug test. Due to our partnership with the Medicare Advantage program, our drug testing policies are consistent with Federal law.
 
Please be aware that Landmark Health does not solicit money or offer payment for job applications, nor do we ask candidates to email or submit any personal information over unsecured channels.


Landmark Health requires all new hires and employees to report their COVID-19 vaccination status.

Keywords: Landmark Health, Santa Ana , Director, Coding, Other , Santa Ana, California

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