Clinical Performance & Quality Coding Manager

Elevance Health; Grand Prairie (TX); Hybrid; USD 110,000 - 150,000; Full time

Job summary

Elevance Health seeks a Manager of Clinical Performance & Quality Coding to lead the documentation and coding accuracy for provider visits. You will oversee CMS risk adjustment initiatives, develop training for clinicians and coders, and coordinate with clinical leadership to improve value capture and HEDIS outcomes.

The role emphasizes in-office collaboration with a hybrid schedule, staff development, and ensuring high-quality documentation across the care continuum.

Qualifications

• Active NP or PA license in the state of residence.
• Master’s in Nursing (or PA equivalent) and at least 3 years of clinical experience applying diagnoses in Medicare HCC Model.
• Experience with CMS Risk Models.

Responsibilities

• Lead CMS risk adjustment and quality documentation efforts.
• Develop and deliver clinical training on advanced coding and documentation.
• Liaise with clinical leadership to align goals and workflows for value capture.
• Develop performance management plans, KPIs and tracking for coding timeliness and accuracy.
• Develop clinical quality reviews and chart audit processes with remediation procedures.
• Create workflows for closing HEDIS care opportunities for plan success.
• Participate in peer review of medical documentation and EMR data.
• Hire, train, coach, and evaluate performance of direct reports.

Skills

CMS Risk Models

Clinical documentation

Training & coaching

Leadership

Quality improvement

Education

Master's in Nursing or PA degree

Nurse Practitioner license (NP) or Physician Assistant license (PA)

Tools

EMR systems

Job description

Elevance Health seeks a Manager of Clinical Performance & Quality Coding to lead the documentation and coding accuracy for provider visits. You will oversee CMS risk adjustment initiatives, develop training for clinicians and coders, and coordinate with clinical leadership to improve value capture and HEDIS outcomes.

The role emphasizes in-office collaboration with a hybrid schedule, staff development, and ensuring high-quality documentation across the care continuum.