Sr. Director, Accurate Clinical Documentation

Wellvana; Nashville (TN); On-site; USD 180,000 - 240,000; Full time

Job summary

Wellvana in Nashville is seeking a Senior Director of Accurate Clinical Documentation to oversee risk adjustment coding/auditing and provider education initiatives across MSSP and MA programs.

The role includes supervising two direct reports and a 23-person organization, managing two vendor relationships, ensuring CMS risk adjustment compliance, and driving strategic programs with data-driven results.

Qualifications

• 10+ years of risk adjustment leadership experience.
• Master's degree preferred in healthcare administration.
• CRC and CPC certifications preferred.

Responsibilities

• Lead risk adjustment strategy and vendor relationships for accuracy and compliance.
• Oversee creation of education materials for clinical documentation providers.
• Ensure CMS risk adjustment compliance and regulatory alignment.
• Recruit, mentor, and lead a 23-person team across multiple functions.
• Provide regular analytics and reporting to senior leadership.

Skills

Risk adjustment leadership

Vendor management

Clinical documentation

Regulatory compliance

Data analysis

Team leadership

Education program development

Education

Master's in Healthcare Admin

CRC & CPC certifications

Job description

The Why Behind Wellvana:

The healthcare system isn’t designed for health. We’re designed to change that. We’re Wellvana, and we help doctors deliver life-changing healthcare.

Description

The healthcare system isn’t designed for health. We’re designed to change that. We’re Wellvana, and we help doctors deliver life-changing healthcare.

Through our elevated value-based care programs, we’re revitalizing an antiquated system that’s far too long relied on misaligned incentives that reward quantity of care not the quality of it.

Our enlightened approach—covering everything from care coordination to clinical documentation education to marketing— ties the healthy outcomes of patients directly to shared savings for primary care providers, health systems and payors.

Providers in our curated network keep their independence, reduce their administrative headaches, and spend more time with patients. Patients, in turn, get an elevated experience with coordinated care between appointments that is nothing short of life-changing.

Named a 2024 "Best in Business" and 2023 "Best Place to Work" by Nashville Business Journal, we’re one of the fastest-growing healthcare companies in America because what we do works. This is the way medicine is meant to be.

Clarity On The Role

Senior Director of Accurate Clinical Documentation is a key leadership position responsible for driving strategic initiatives, vendor management, and operational efficiency within the Wellvana Clinical Documentation organization. This position requires a seasoned professional with a strong background in Clinical Documentation Improvement. This includes experience managing vendors, coding teams, implementing new services, and coding quality assurance. The Accurate Clinical Documentation Sr Director role will lead service delivery and oversight of the risk adjustment coding/auditing team and clinical documentation provider education team, leading 2 direct reports (Sr. Manager level) and a total org of 23 team members. The Sr Director will own oversight of two key vendor relationships performing Clinical Documentation services. The position will oversee and optimize clinical documentation programs while ensuring high-quality education and training for Wellvana’s partners, members of our ACOs. This role involves strategic planning, risk assessment, operational leadership, and compliance management.

What's Expected

Clinical Documentation Strategy

• Lead teams and vendors to execute a comprehensive clinical documentation/risk adjustment strategy in alignment with Wellvana's goals and objectives.
• Provide input into continued refinement of comprehensive strategy and overall partner services support, tools, technology, analytics, etc
• Raise people, process, and technology concerns and opportunities to senior leadership and provide input into solutions
• Oversee clinical documentation processes to accurately capture patient acuity and severity for appropriate benchmarks and reimbursement across Wellvana’s line of businesses (currently MSSP and MA).

Educational Program Management

• Execute strategy of segmenting and stratifying partners and practices for provider education services: full service, hybrid, and consultative. Assist in refining strategy where needed
• Oversee creation of relevant curriculum and training materials for clinical documentation provider education

Compliance And Regulatory Oversight

• Ensure compliance with all relevant healthcare regulations, including CMS guidelines for risk adjustment.
• Stay updated on changes in regulations and adjust strategies and programs accordingly.

Team Leadership

• Recruit, mentor, and lead a team of professionals responsible for risk adjustment coding/auditing team and clinical documentation provider education
• Foster a culture of continuous learning and improvement within the team.

Data Analysis And Reporting

• Measure results of programs and monitor success against Wellvana and partner level targeted goals for improvement of benchmark accuracy and other key performance indicators
• Provide regular reports to senior leadership and stakeholders.
• Provide guidance

Collaboration And Stakeholder Engagement

• Collaborate with healthcare providers, payers, and internal departments to ensure accurate risk capture and reporting.
• Engage with key stakeholders to align risk adjustment, quality, and clinical education initiatives and services.
• Strategize with the Partner Success team on engagement tactics and relationship-building processes for ACD team to engage with practices

Quality Assurance

• Implement quality assurance processes to monitor the effectiveness of programs, both internal and vendor
• Monitor vendor adherence to SLAs and mitigate issues

Continuous Improvement

• Identify areas for improvement in risk adjustment and quality education programs, clinical documentation services, vendors, and technology and implement changes to drive better outcomes.
• Encourage innovation and the adoption of best practices.

Requirements

What’s Required:

• Integrity: The right way is the only way.
• Dependability: You do what you say you’re going to do.
• Advocacy: You fight for the best possible outcome for providers and their patients.
• Clarity: You make it all understandable.

Education (Degree/Major)

• A master's degree or higher in healthcare administration, healthcare management, or a related field is preferred

Certifications

• CRC & CPC is preferred

Years Of Related Experience

• 10+ years of experience in Risk Adjustment operations and leadership with Medical Coding, Auditing and Education operations or vendor management preferred

Skills

• Significant experience in risk adjustment or revenue cycle management
• Experience managing risk adjustment vendors
• Experience in Quality preferred
• Strong knowledge of healthcare regulations, especially related to risk adjustment.
• Excellent leadership and team management skills.
• Proficiency in data analysis and reporting.
• Effective communication and interpersonal abilities.
• A commitment to continuous learning and staying updated on industry trends.
• Experience with educational program development and delivery is a plus.