Sr. Manager, Coding Quality & Vendor Oversight bei Canohealth

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Job Summary

The Sr. Manager, Coding Quality & Vendor Oversight oversees the quality and compliance of outsourced medical coding (post-visit) vendors. Responsibilities include evaluating nearshore and offshore teams’ performance, overseeing vendor audits, implementing process improvements, and ensuring compliance with the requirements of Medicare, Medicaid, and commercial payers.

Essential Duties & Responsibilities

• Lead and monitor third-party medical coding vendors for adherence to contracts, SLAs, and coding standards.
• Serve as the primary liaison between the organization and external coding partners.
• Conduct regular vendor performance reviews to assess coding accuracy, timeliness, and compliance.
• Oversee audits of CPT, ICD-10-CM, and HCPCS codes related to outpatient primary care, preventive services, pediatric visits, and chronic care management.
• Ensure vendor coding aligns with CMS (Medicare/Medicaid), state-specific Medicaid policies, and commercial payer rules (e.g., HEDIS, EPSDT).
• Monitor for potential issues such as upcoding, under coding, and incorrect use of E/M or preventive service modifiers.
• Track key metrics including vendor coding accuracy, turnaround time, denial rates, and audit findings.
• Provide detailed reports and insights into vendor performance and coding trends.
• Collaborate with vendors to implement corrective actions and training programs based on audit results and regulatory updates.
• Work with clinical, billing, and compliance teams to support accurate documentation and code capture.
• Stay current with CMS guidelines, Medicaid billing policies (state-specific), and commercial payer coding changes.
• Strong knowledge of CMS, Medicaid, and commercial payer coding guidelines.
• Experience auditing E/M, well visits, sick visits, immunizations, and chronic disease management coding.
• Ensure vendor compliance with policies affecting fee-for-service, preventive care billing, vaccine coding, and telehealth services.
• Support data audits, regulatory reporting, and HIPAA compliance efforts.
• Monitor data quality metrics and lead remediation efforts for anomalies or inconsistencies.

Education & Experience

• Bachelor’s degree in health information management, Nursing, Healthcare Administration, or related field.
• 5-7 years of relevant experience
• 2+ years in a leadership or vendor oversight role
• RHIA, RHIT, CCS, CPMA, CPC Certification

Education Requirements

Education Level

Discipline

Required

Bachelor's Degree

in health information management, Nursing, Healthcare Administration, or related field.

Knowledge, Skills & Proficiencies

• Comprehensive knowledge of all Microsoft Office applications, including Word, Excel, and PowerPoint
• Ability to communicate effectively and sensitively with team members in stressful situations.
• Possess strong business acumen, excellent strategic thinking, and effective critical thinking skills.
• 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.
• Expertise in CPT, ICD-10-CM, HCPCS, and outpatient documentation guidelines.
• Proficient in EHR systems (e.g., eCW, Athena, NextGen) and coding tools (e.g., 3M, EncoderPro).
• Strong analytical, problem-solving, and communication skills.
• Knowledge of HEDIS measures
• Key Performance Metrics
• Vendor coding accuracy rate (%)
• SLA compliance (turnaround time, audit response time)
•  Reduction in claim denials due to coding errors 
• Corrective action implementation rate
•  Audit pass rate (internal and external reviews)

Physical Requirements

This position works under usual office conditions. The associate is required to work at a personal computer as well as be on the phone for extended periods of time. Must be able to stand, sit, walk and occasionally climb. The incumbent must be able to work extended and flexible hours and weekends as needed. Physical demands include ability to lift up to 50 lbs. The physical demands described here are representative of those that must be met by an associate to successfully perform the essential functions of the job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Work Conditions

Must be able to perform essential functions such as typing, standing, sitting, stooping, and occasionally climbing. 

Travel Requirements

Amount of Expected Travel

Details

Yes

0-25%

Flexibility to travel to clinical sites as needed

Tools & Equipment Used

Computer and peripherals, standard and customized software applications and tools, and usual office equipment.

Disclaimer

The duties and responsibilities described above are designed to indicate the general nature and level of work performed by associates within this classification. It is not designed to contain, or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of associates assigned to this job. This is not an all-inclusive job description; therefore, management has the right to assign or reassign schedules, duties, and responsibilities to this job at any time. Cano Health is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.

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