Lead Clinical Performance & HCC Coding Manager

Elevance Health; Mason (OH); Hybrid; USD 110,000 - 140,000; Full time

Benefits offered by this job

Merit increases

Paid holidays

Paid Time Off

Incentive bonus programs

Medical benefits

Dental benefits

Vision

401(k) match

Stock purchase plan

Life insurance

Wellness programs

Financial education resources

Job summary

Elevance Health seeks a Manager Clinical Performance & Quality Coding to lead CMS Risk Adjustment and quality documentation for provider visits. The role combines in-office collaboration with flexible hybrid work, requiring 3 days on-site per week within commuting distance.

The ideal candidate has NP or PA licensure with a Master's in Nursing and 3+ years in Medicare HCC coding, CMS risk models experience, and prior management experience.

Qualifications

• Requires NP or PA license in the state of residence.
• Master's in Nursing (or PA equivalent) with 3+ years of clinical experience in Medicare HCC.
• Experience with CMS Risk Models.

Responsibilities

• Lead CMS Risk Adjustment and quality documentation.
• Develop and deliver clinical training on coding and documentation.
• Align goals/workflows with clinical leadership to support value capture.
• Create performance metrics and tracking for coding timeliness and accuracy.
• Oversee clinical quality reviews and remediation processes.
• Develop workflows for closing HEDIS opportunities to drive plan success.
• Participate in peer reviews of notes and patient profiles in EMR.
• Hire, train, coach, and evaluate direct reports.

Skills

Clinical documentation

CMS Risk Adjustment

Leadership/people management

Training and development

Education

Master's in Nursing

Nurse Practitioner license (NP)

Physician Assistant license (PA)

Tools

EMR systems

HEDIS data tools

Job description

Elevance Health seeks a Manager Clinical Performance & Quality Coding to lead CMS Risk Adjustment and quality documentation for provider visits. The role combines in-office collaboration with flexible hybrid work, requiring 3 days on-site per week within commuting distance.

The ideal candidate has NP or PA licensure with a Master's in Nursing and 3+ years in Medicare HCC coding, CMS risk models experience, and prior management experience.