Remote Director of Coding Quality & Compliance

Complexcare Solutions, Inc.; United States; On-site; USD 132,000 - 174,000; Full time

Job summary

ComplexCare Solutions, Inc. is seeking a Director of Clinical Coding Quality to lead the coding quality function across the organization in a remote capacity. The role focuses on CMS risk adjustment, HCC coding, and documentation integrity while coordinating with health plan clients and internal teams.

You will oversee audits, vendor performance, and the development of coding guidance and QA tools, ensuring regulatory compliance and continuous improvement in documentation accuracy.

Qualifications

• Minimum five (5) years’ management experience in healthcare leadership.
• Minimum two (2) years’ nursing experience.
• Strong knowledge of CMS Risk Adjustment, HCC Coding Methodology, ICD-10-CM, CDI, RADV and OIG.
• Experience auditing coding quality and managing external vendors.
• Experience developing coding policies, audit methodologies, and quality programs.

Responsibilities

• Oversee day-to-day operations of Clinical Coding Quality, including audits and vendor performance.
• Coordinate coding quality audits and documentation integrity reviews.
• Monitor HCC accuracy and audit readiness, driving improvements.
• Develop and maintain coding guidance, standards, and QA tools.
• Provide oversight of external coding vendors and remediation activities.
• Support CMS, RADV, and OIG audits and regulatory compliance.

Skills

Leadership

Attention to detail

Project management

Verbal and written communication

Microsoft Office

Data collection tools

Healthcare knowledge

Education

Bachelor's degree

Master's degree preferred

Coding certifications (CRC CPC CCS)

RN license preferred

Tools

Vendor management tools

Job description

ComplexCare Solutions, Inc. is seeking a Director of Clinical Coding Quality to lead the coding quality function across the organization in a remote capacity. The role focuses on CMS risk adjustment, HCC coding, and documentation integrity while coordinating with health plan clients and internal teams.

You will oversee audits, vendor performance, and the development of coding guidance and QA tools, ensuring regulatory compliance and continuous improvement in documentation accuracy.