Director, Quality, Clinical Coding and Documentation

📋 Description

• Own HEDIS and Medicare Advantage Star Ratings strategy and targets; drive accountability across
• Lead end-to-end quality gap closure; identify gaps, plan outreach, scheduling, and closed-loop
• Embed quality improvement into daily operations with pre-visit planning and workflows.
• Manage annual quality calendar, RAF accuracy, and NCQA submissions with audits and reporting.
• Lead end-to-end risk adjustment program including CMS-HCC V28; oversee documentation priorities and
• Design and lead the clinical documentation integrity program with provider queries and

🎯 Requirements

• Bachelor’s degree in health information management, nursing, healthcare administration, or related
• Active coding certification (CPC, CRC, CCS, CCS-P, RHIA, RHIT); CRC preferred.
• 7+ years in medical coding, risk adjustment, or CDI; 3+ years in leadership.
• Deep knowledge of CMS-HCC risk adjustment and v24 to v28 transition implications.
• Experience with RADV or payer audit response; defensibility of medical records.
• Strong knowledge of ICD-10-CM guidelines and NCQA/HEDIS methodologies; ability to educate

🎁 Benefits

• Full-time, exempt Director-level position.
• Hybrid work in Twin Cities metro; travel to clinics; remote arrangements with market travel
• Opportunity to lead quality, coding, CDI, and risk adjustment infrastructure in a growth healthcare
• Exposure to executive leadership, payer partners, and cross-functional teams.
• Chance to shape scalable programs and standards for broader markets.
• Occasional travel and support for professional development in quality and healthcare operations.