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Manager, Clinical Performance & Quality Coding – Nurse Practitioner or PA
Elevance Health. Lead quality documentation and value capture for provider visit medical encounters .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in ICD-10 diagnosis coding, CMS Risk Adjustment, and clinical documentation integrity, while effectively leading training and quality initiatives to enhance coding accuracy and compliance. Proven ability to manage clinical workflows and performance metrics to support value capture in healthcare settings.
Highest-signal resume keywords
ICD-10 Diagnosis CodingCMS Risk AdjustmentClinical Documentation IntegrityHEDIS ExperienceAAPC Certified Risk Adjustment Coder (CRC)
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Clinical Quality ReviewsPeer ReviewsChart AuditsPerformance Management PlansKPI DevelopmentOperational WorkflowsClinical Training DevelopmentCoder Feedback IncorporationValue Capture InitiativesMedicare HCC Model
Soft Skills
LeadershipCoachingCommunicationCollaborationEvaluation
Tools & Technologies
EMR
Certifications & Qualifications
Nurse Practitioner (NP) LicensePhysician Assistant (PA) LicenseAAPC Certified Risk Adjustment Coder (CRC)
Industry Keywords
HEDISCMS Risk ModelsClinical Data IntegrityQuality DocumentationValue Capture
About the role
Key responsibilities & impact- Lead quality documentation and value capture for provider visit medical encounters
- Ensure accurate ICD-10 diagnosis coding
- Serve as subject matter expert on CMS Risk Adjustment and quality documentation
- Develop and deliver clinical-focused training on advanced coding and documentation
- Incorporate coder feedback into training and documentation practices
- Liaise with clinical leadership to align goals and workflows supporting value capture initiatives
- Develop performance management plans, KPIs, and clinical-level tracking for quarterly coding goals
- Develop and manage clinical quality reviews, peer reviews, and clinical quality chart audits
- Establish chart-review targeting, audit percentages, scoring guidelines, feedback mechanisms, and remediation compliance
- Develop operational and clinical workflows to close HEDIS care opportunities
- Participate in peer review of medical documentation and patient profile information in the EMR
- Hire, train, coach, counsel, and evaluate direct reports
Requirements
What you’ll need- Current, active, valid, and unrestricted nurse practitioner (NP) or physician assistant (PA) license from the state in which you reside
- Master's in Nursing or PA equivalent
- At least 3 years of clinical experience applying appropriate diagnosis in the Medicare HCC Model, or an equivalent combination of education and experience
- Experience with CMS Risk Models
- Previous management/supervisory experience with direct reports
- HEDIS experience preferred
- Experience with clinical data/documentation integrity preferred (CDEO or CDEI)
- AAPC Certified Risk Adjustment Coder (CRC) certification preferred
- Ability to work in the office 3 days per week
- Must be within a commutable distance of an eligible office
- Ability to work Monday through Friday, 8–5 Central
Benefits
Comp & perks- Merit increases
- Paid holidays
- Paid Time Off
- Incentive bonus programs
- Medical benefits
- Dental benefits
- Vision benefits
- Short-term disability benefits
- Long-term disability benefits
- 401(k) match
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources
- Hybrid work flexibility
- Professional and personal growth opportunities