Sr. Director, Clinical Training & Quality of Coding Operations

Sr. Director, Clinical Training & Quality of Coding Operations
Remote Opportunity

POSITION SUMMARY:

Reveleer is a healthcare data and analytics company that uses Artificial Intelligence to give health plans across all business lines greater control over their Quality Improvement, Risk Adjustment, and Member Management programs. With one transformative solution, the Reveleer platform enables plans to independently execute and manage every aspect of enrollment, provider outreach and data retrieval, coding, abstraction, reporting, and submissions. Leveraging proprietary technology, robust data sets, and subject matter expertise, Reveleer provides complete record retrieval and review services so health plans can confidently plan and execute risk, quality, and member management programs to deliver more value and improved outcomes.

As the Senior Director of Training and Quality of Coding Operations, you will be responsible for overseeing and optimizing the training and quality of the clinical department’s operations. Your primary focus will be on assuring Reveleer has a top in class training/onboarding and quality program that results excellent clinical performance, employee engagement, retention, and customer satisfaction. You will play a critical role in driving accuracy, and continuous improvement of the coding processes while fostering a positive and supportive work environment.

ESSENTIAL FUNCTIONS:

Training and On-boarding:

• Work with the VP of training to make sure that all training programs are developed to include personal learning styles.
• Work to assure the training and onboarding process does not have bottlenecks. The goal is to get someone onboarded into production within a week.
• Assure that all clinical programs have 95% or better quality or an action plan to get them there.
• Assure that all individual coders have a 95% or better or the proper action plans, training and remediation happen.
• Track the numbers and costs of quality issues, turnover, and rework
• Develop best practices workflows and reporting to assure high quality results
• Develop a quality program that meets our contractual obligations as well as assures our coders are performing at an optimal level to meet customer expectations.
• Work within the guidelines to meet budget obligations and reduce the amount of over-read and re-work.
• Collaborate with HR to recruit, hire, and onboard coding professionals with the required skill set and expertise.
• Monitor coding staff workload and redistribute resources as needed to meet operational demands.

Productivity and Quality Management:

• Establish key performance indicators (KPIs) for coding productivity and accuracy.
  • 95% quality
  • 5% rework
  • 10% over-read
• Monitor coding processes to identify bottlenecks, inefficiencies, and areas for improvement.
• Implement process enhancements to streamline workflows and increase productivity while maintaining high-quality standards.

Coding Education:

• Oversee a comprehensive training program for coding staff to ensure continuous skill development and compliance with industry standards.
• Stay updated with evolving coding guidelines, regulations, and technologies, and integrate these updates into training materials.
• Conduct regular training sessions and workshops to improve coding proficiency and keep staff up to date.
  • Identify error trending and develop course work to focus on specific problem areas

Employee Engagement and Retention:

• Develop and implement strategies to foster a positive work environment that encourages collaboration, innovation, and personal growth.
• Conduct regular feedback sessions, performance evaluations and career development discussions with coding staff.
• Assess employee concerns, resolve conflicts, and create initiatives to improve satisfaction and retention.

Data Analysis and Reporting:

• Collect, analyze, and present operational data and performance metrics to senior leadership.
• Provide insights and recommendations to drive strategic decision making and operational excellence.
• Develop reports that showcase productivity, quality, and employee engagement trends.

QUALIFICATIONS/EDUCATION/CERTIFICATIONS

• Bachelor’s degree or equivalent experience is required.
• Certified Coding Specialist (CCS) required.
• Experience working in Payer HCC Risk and Quality Program.
• Experience with HEDIS Measures.
• 5 years’ experience managing Coding Operations.

WHAT YOU’LL RECEIVE:

• Competitive salary 
• Medical, Dental and Vision benefit
• Employee Assistant Plan 
• 100% employer paid life insurance
• 100% employer paid short and long term disability
• 401k with Employer Match
• Generous PTO plan and Summer Fridays

SALARY RANGE: $160,000 - $180,000 / annually

Our compensation reflects the cost of labor across several US geographic markets. Pay is based on several factors including market location and may vary depending on job-related knowledge, skills, and experience.

Reveleer E-Verifies all new hires.

Reveleer is an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, gender identity, sexual orientation, age, marital status, veteran status, disability status or genetic information, in compliance with applicable federal, state and local law.