Drive operational excellence across provider risk adjustment, HCC coding, and value-based care programs while overseeing coding services delivered by domestic and global teams.
Serve as the primary strategic lead and escalation point for health plan and provider clients, maintaining accountability for service quality and client satisfaction.
Manage, mentor, and develop diverse coding teams across locations, ensuring coding activities follow organizational standards and regulatory requirements.
Drive day-to-day operational execution of Medicare Advantage and ACA Risk Adjustment initiatives, ensuring milestones and deadlines are met.
Develop and maintain integrated project plans, operational calendars, and risk logs to support program execution.
Monitor program performance through dashboards, KPIs, and operational metrics, and recommend data-driven improvements.
Capital Blue Cross is a health insurance company and an independent licensee of the Blue Cross Blue Shield Association. They are consistently voted one of the 'Best Places to Work in PA' and foster a flexible environment with a focus on employee wellbeing.
Serve as the primary client relationship lead, ensuring alignment on goals, scope, deliverables, and outcomes.
Provide OP HCC CDI subject matter expertise and oversee project execution, quality, and client satisfaction.
Monitor project performance, manage risks and scope changes, and ensure successful delivery of contracted services.
UASI improves the quality and accuracy of clinical documentation through expert CDI consulting. We are a growing team with a collaborative, mission-driven environment that values continuous learning and professional growth.
Own strategy and execution for go-to-market efforts across Aledade's Risk Stratification program.
Build strategic partnerships with payer partners and large practice leaders to advance accurate diagnosis documentation.
Coordinate cross-functional teams and provide expertise to drive risk stratification initiatives.
Aledade is a public benefit corporation that empowers independent primary care. Founded in 2014, it has become the largest network of independent primary care in the country, fostering a collaborative and remote-first culture.
Provides oversight of coding teams, holding them accountable to enterprise established KPIs, including DNFC.
Manages staff to ensure coding team meets productivity and quality standards, developing performance improvement plans as needed.
Acts as a liaison between CDI, physicians, clinical quality, and patient financial services to ensure accuracy and integrity of inpatient medical records.
CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation's largest nonprofit Catholic healthcare organizations, it has more than 157,000 employees and operates across 24 states, delivering over 20 million patient encounters annually.
Monitor denial volumes, aging, and identify trends to improve coding quality processes.
Develop and implement new programs, processes, and standards to streamline workflows and enhance efficiency.
Collaborate with leadership to support annual and long-term strategy planning and execute departmental goals.
UnityPoint Health is a healthcare system dedicated to providing quality care and has been recognized as a Top 150 Place to Work in Healthcare. They foster a culture of belonging and offer support and development opportunities for their team members.
Assist with retrospective and concurrent coding for PACE Dual participants.
Conduct pre-visit chart preparations and post-visit chart reviews.
Oversee audits and participate in provider education programs to ensure compliance with CMS risk adjustment diagnosis coding guidelines.
WelbeHealth provides seniors with the opportunity to continue living in their homes through its PACE program. The company employs a collaborative interdisciplinary team approach and values diversity and inclusion.
CommonSpirit Health is one of the largest nonprofit Catholic healthcare organizations in the US, providing integrated health services across 24 states with over 157,000 employees. It is driven by innovation and faith, committed to creating a just, equitable healthcare system.
Serves as a subject matter expert in clinical documentation quality, risk adjustment, and HCC coding integrity.
Performs prospective reviews of medical records to validate chronic conditions and ensure documentation accuracy.
Utilizes Epic and OurPractice Advisories to support accurate coding, HCC capture, and compliance.
UASI is a clinical documentation improvement consulting firm dedicated to improving the quality and accuracy of clinical documentation. They offer a collaborative, mission-driven environment with opportunities for professional growth.
Lead clinical programming and quality initiatives, including Stars/HEDIS strategy and risk coding documentation improvement.
Collaborate with Product, Engineering, and Analytics to design AI-enabled clinical tools and workflows.
Drive data-driven outcomes by monitoring metrics and identifying opportunities for intervention and improvement.
Chamber Cardio rebuilds the cardiology system by partnering with independent cardiologists to improve population health through technology, data, and operational tools. They are a mission-driven organization focused on innovation and empathy, blending clinical expertise with modern operating platforms.
Oversees CDI teams, ensuring optimal performance and compliance with regulatory requirements.
Develops strategic plans to achieve enterprise KPIs and analyzes data for monthly performance reports.
Acts as liaison between physicians, coding, and clinical quality to ensure accuracy of inpatient medical records.
CommonSpirit Health is a nonprofit Catholic healthcare organization delivering integrated health services. With over 157,000 employees, it is one of the nation's largest healthcare systems, focused on innovation and community care.
Lead strategic initiatives to improve STARS, CAHPS, PWP, and HEDIS performance across the health plan.
Manage a team of 3-6 direct reports and collaborate with cross-functional teams.
Design and evaluate outreach programs to enhance member experience and close care gaps.
Sentara Health Plans provides health plan coverage to close to one million members in Virginia. It is part of Sentara Health, a not-for-profit integrated healthcare provider with nearly 30,000 employees and a family-friendly culture.
Translate risk adjustment performance data into clear financial insights, including revenue impact, payment accuracy, ROI, and forecasting.
Analyze CMS data to identify opportunities for increasing operational efficiency and interpret trends to assess program and policy impacts.
Prepare and deliver clear reports and presentations to senior leadership, translating technical findings into actionable business recommendations.
Strive Health is on a mission to transform chronic conditions by identifying risk earlier and coordinating thoughtful care to reduce emergency visits and improve outcomes. The company offers a hybrid-remote flexibility model with comprehensive benefits and a culture described as passionate, one-team oriented, and focused on making an impact.
Conduct prospective chart reviews to validate ICD-10-CM and CPT coding accuracy.
Provide clinical documentation improvement feedback to providers on documentation gaps.
Ensure compliance with risk adjustment and regulatory coding guidelines.
Thyme Care is a cancer care navigation company transforming the cancer care experience through value-based care. They are building a diverse, mission-driven team to reshape the future of healthcare.
Lead operational improvement strategies and transformation programs across healthcare service operations.
Drive end-to-end program delivery including planning, risk management, and executive communications.
Conduct operational assessments, root cause analysis, and design enablement materials to support process adoption.
This partner company in the healthcare technology sector drives operational excellence and transformation across complex service environments. It is a remote-first organization with a supportive culture focused on innovation and continuous improvement.
Serve as a subject matter expert for specialty value-based programs, establishing evidence-based approaches and priorities.
Lead strategic program delivery, coordinating implementation plans, timelines, and stakeholder commitments.
Evaluate program performance, translate findings into actionable recommendations, and advise executives.
The partner company is a healthcare organization focused on advancing strategic value-based programs within a complex healthcare environment. It operates with a remote-first culture and emphasizes collaboration, innovation, and executive-level impact.