IPA Coding Associate Director

Become a part of our caring community and help us put health first

The IPA Coding Leader manages a diverse team responsible for ensuring clinical documentation supports accurate coding and is reflective of the disease prevalence within the population. The IPA Coding Leader partners with IPA strategic partners to develop market-specific strategies to promote accurate clinical documentation, ensures all state, federal and internal policies and procedures are followed, and fosters collaboration across entities within the Primary Care Organization.

Strategy:

• In partnership with AVP, Risk Adjustment and AVP, MRA Strategy, responsible for driving ongoing efficiency and effectiveness of the divisional teams through use of people, processes, and technology enablement (including Annual Proof of Documentation (APD) tool)

• Responsible for performance management and strategy development for PCO risk adjustment at the division and market level; Partners with Clinical Documentation Improvement, Audit, and Education to develop programs to improve clinical documentation.

• Partner with MRA Strategy and Analytics teams to establish risk adjustment analytics to identify coding improvement opportunities, provider coding improvement opportunities, risk score trending and tracking.

• Partners with MRA and IPA Strategy Leaders to identify and influence enhancements to technology to improve the medical coder experience.

• Oversees coding operations by identifying business partner needs and develops solutions.

• Responsible for overall performance of IPA coding teams.

IPA Dyad Partnership/Influence:

• Collaborates with analytical resources to develop, communicate, and present analyses of KPIs for the division, individual markets, and clinics to determine areas of opportunity (unlocked notes, pending addendums, etc. Presents analyses to IPA Dyad partners monthly.

• Partner with IPA Dyad leaders to develop and implement improvement programs and the clinic, market, and provider level; includes monitoring and refinement of existing programs and strategies to identify opportunities for improvement.

• Proactively communicate performance, opportunities, and risks to IPA Dyad Partners

• Partners with IPA leaders to support special projects. Includes development of action plans in partnership with IPA leadership.

• Identify/share best practices within the markets and divisions to foster consistent, compliant workflows.

• Partner with Analytics teams to address data outages and communicate remediation plan to IPA Dyad partners.

• Partners with market operational leaders to identify operational issues that impact clinician and coder performance.

• Facilitate meetings with key partners, including Clinical, Operations, Analytics, etc. to address concerns and resolve issues.

• Partner with IPA Dyad leaders to ensure smooth integration of newly acquired IPA affiliates.

Productivity and Quality Management:

• Establish Key Performance Indicators (KPIs) for coding productivity and accuracy (90% coder accuracy)

• Monitor coding staff workload and redistribute resources as needed to meet market operational demands.

• Monitor coding processes, identify inefficiency, and develop recommendations for improvement.

• Partner with Operational Excellence team to identify process enhancements and streamline workflows as needed.

Coder Education:

• Based on coder audits and in partnership with the training organization, develop comprehensive training program for coding staff to ensure continuous skill development and compliance with coding standards.

• Partner with analytics and audit to identify coder errors and develop plans to address deficiencies/specific areas of focus.

Associate 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.

Use your skills to make an impact

Required Qualifications

• Minimum 5 years of management experience

• 8 or more years of Medical Coding, IPA, or similar experience

• Medical Coding Certification

• Experienced team leader with success leading large, collaborative efforts and teams, including direct-reports and matrixed functions

• Proven ability to drive medical coding program effectiveness and oversight across multiple sites and geographies, with concrete impact on business outcomes

• Ability to travel up to 20%

Preferred Qualifications

• Proven experience with Medicare Advantage risk adjustment functions.

• Proven track record of working collaboratively with clinical and operational colleagues across the organization.

• Bachelor's degree in business in business, healthcare administration, or related field.

Knowledge, Skills, and Abilities:

• Comprehensive knowledge of all Microsoft Office applications, including Word, Excel, and PowerPoint

• Ability to communicate effectively and sensitively with clinicians and team members in stressful situations.

• Ability to lead by influence to engage colleagues and lead teams cross-functionally.

• Experience in fostering networks with internal and external stakeholders.

• Possess strong business acumen, excellent strategic thinking, and effective critical thinking skills.

• Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction or guidance.

• Excellent verbal and written communications skills with demonstrated ability to communicate, present, and influence both credibly and effectively at all levels of an organization.

• Ability to work in a rapidly changing, matrixed environment.

• Has a positive, collaborative mindset to foster partnership within and the Coding, Audit, and Education department, the PCO, and Humana

• Bachelor's Degree

• 6 or more years of technical experience

• 2 or more years of management experience

• RHIA, RHIT, CCS, CPC Certification

• MS-DRG auditing or APR auditing experience

• Acute in-patient and/or outpatient coding experience

• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Additional Information

RHIA, RHIT, CCS, CPC Certification