The Director, Coding and CDI is responsible for overseeing the post-visit coding review program, including the performance of market coders, leased coders, and the management of the coding pool. This role is accountable for the coding quality assurance program and the monitoring and evaluation of coding practices across the organization. Additionally, the Director will lead strategic initiatives, drive innovation, and ensure alignment with organizational goals. In collaboration with Clinical teams at both the platform and market levels, as well as market BOI leaders, this role will provide coding and clinical documentation improvement education to identified providers.

• Strategic Leadership: Develop and implement agilon health BOI strategy surrounding post-visit coding review.

• Collaboration: Partner with market leaders on post-visit coding review strategy, including provider engagement and education.

• Program Development: Oversee the development and implementation of post-visit review coding programs.

• Oversight and Education: Lead the oversight and education of all coders.

• Quality Assurance: Manage the Quality Assurance program related to coding practices.

• Guideline Creation: Assist with the creation of all coding guidelines and workflows with minimal market variation.

• Provider Education: Develop and oversee the provider education program for coding and clinical documentation improvement.

• Data Utilization: Use data, reporting, and analytics to identify areas of opportunity.

• Partnerships: Collaborate with Clinical team, market teams, and performance management teams on provider remediation.

• Compliance: Partner with compliance on the execution of the coding program.

• Active Management: Use active daily management to ensure targets are achieved and identify and escalate potential barriers. • Innovation: Drive innovation in coding practices and documentation improvement.

Other Job Functions:

• Understand, adhere to, and implement the Company’s policies and procedures.

• Provide excellent customer service skills, including consistently displaying awareness and sensitivity to the needs of internal and/or external clients. Proactively ensure that these needs are met or exceeded.

• Take personal responsibility for personal growth, including acquiring new skills, knowledge, and information. • Engage in excellent communication, which includes listening attentively and speaking professionally.

• Set and complete challenging goals. • Demonstrate attention to detail and accuracy in work product.

Minimum Experience:

• 10+ years of experience in managed care or the health care industry with a focus on government programs strongly preferred.

• 12+ years of coding experience (CPT, ICD-9/10, HCPCS).

• 10+ years of experience as a clinical documentation specialist.

• Proven experience in providing feedback and education to providers on coding and clinical documentation.

• Firm understanding of CMS HCC Risk Adjustment Model.

• Experience with previous risk adjustment program teams.

• Demonstrated leadership experience with diverse teams. • Strong analytical skills. • Excellent collaboration and communication skills with the ability to influence change across teams.

Education/Licensure:

• Bachelor’s degree required, Master’s degree preferred.

• One of the following Coding Certifications: CCS, CCS-P, CCA through AHIMA or CPC, COC, CIC through AAPC required. • RHIA and/or RHIT required.

1. Language Skills: Strong communication skills, both written and verbal, to work with multiple internal and external clients in a fast-paced environment.

2. Mathematical Skills: Ability to work with mathematical concepts such as probability and statistical inference. Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.

3. Reasoning Ability: Ability to apply principles of logical or scientific thinking to a wide range of intellectual and practical problems.

4. Computer Skills: Proficiency in creating and maintaining documents using Microsoft Office (Word, Excel, Outlook, PowerPoint).

5. Other Skills and Abilities: Demonstrated ability to lead strategic initiatives and drive innovation in coding and clinical documentation improvement.