Clinical Documentation Manager
Core
Subject matter expert driving clinical documentation integrity and ICD-10-CM coding accuracy for Medicare Advantage Risk Adjustment, enabling provider network support and audit readiness.
Role type
Individual contributor Clinical Documentation Manager (Risk Adjustment)
Builds
Condition-specific clinical documentation guidance, EHR template recommendations, network-wide webinars, and audit rebuttals.
Domain
Healthcare / Medicare Advantage Risk Adjustment / Clinical Documentation Integrity
Required skills
Medicare Advantage Risk Adjustment (CMS-HCC) expertise, ICD-10-CM coding guidelines, audit rebuttal execution, medical record chart reviews, AAPC/AHIMA/ACDIS credential, compliance adherence, data-driven trend analysis
Preferred skills
Clinical licensure (RN/NP/PA/MD), generative AI/LLM workflows, healthcare data analytics, cross-functional workgroup experience
Technologies
EHR systems, AI-assisted workflows, automated tracking mechanisms, spreadsheets, dashboards
Responsibilities
Lead CDI thought partnership with Risk Adjustment leadership; design and maintain clinical documentation guidance and education assets; partner with Practice Consultants on provider engagements and JOC presentations; support external and internal audit responses; pioneer AI solutions for CDI research and audit readiness; develop clinical logic for risk adjustment insights; conduct quality reviews and trend analysis
Seniority
Mid-level, hands-on IC
