Clinical Coding Manager

Reveleer delivers a unified platform spanning risk adjustment, quality improvement, clinical intelligence, and member management for health plans and provider organizations navigating the complexity of value-based care. Trusted by 80+ customer organizations nationwide, the platform integrates data, analytics, and intelligent workflow automation into one governed system designed to support traceable documentation across diagnoses, quality measures, and submissions. With regulatory expertise and transparent, human-in-the-loop AI at its core, Reveleer supports organizations working to advance care quality, strengthen documentation integrity, and sustain the operational readiness needed to navigate audits with confidence.

Responsibilities

• Oversee and/or perform an accurate medical record review for all RISKSupport and participate in process and quality improvement initiatives.
• Conduct training related to RISK platform usage, update any training materials, and function as RISK SME.
• Monitor project status and work on flexible projects with variable client/project-specific guidelines.
• Review all Negative / Positive hits.
• Manage RISK coding projects when needed, including project status and completing chart reviews for coding projects.
• Analyze medical records and NLP results and validate that the clinical evidence meets the necessary requirements for submission and documentation, ensuring it accurately reflects the patient's conditions, treatment, and services provided.
• Identify gaps, inconsistencies, and discrepancies in documentation that could impact patient care, quality reporting, and reimbursement.
• Ensure documentation aligns with accurate code assignment and follow CMS's coding guidelines for HCC risk adjustment coding.
• Maintain a deep understanding of medical terminology, disease processes, treatments, and procedures to accurately interpret and validate clinical documentation.
• Safeguard the integrity and confidentiality of patient health information while handling medical records and sensitive data in accordance with HIPAA and other relevant regulations.
• Foster clear communication and collaboration between different healthcare departments, ensuring accurate patient information is shared across the continuum.

Requirements

• Must have a professional coding certificate through AHIMA/AAPC.
• Minimum of 5 years of hands-on medical records experience.
• 5 years of RISK and IVA experience.
• 3+ years of management experience.
• Background in UR, QA, and/or QI experience preferred.
• Strong computer skills and high-speed internet access at home.
• Commitment to confidentiality of patient health information.
• Professional, articulate, and able to work independently.
• Ability to manage teams and meet deadlines.
• Ability to conduct trainings in nonstandard time frames to meet abstractor needs and training.

Benefits

• Competitive salary.
• Medical, Dental, and Vision benefits.
• 401k match.
• Generous PTO plan.

Our compensation reflects the cost of labor across several US geographic markets. Pay is based on several factors including market location and may vary depending on job-related knowledge, skills, and experience.