IPA Consultative Coding Manager

About the role

The Manager, IPA Consultative Medical Coding leads a team of consultative coders supporting value-based care delivery across a defined geographic region. You will oversee regional coding operations to ensure agreement on provider engagement, risk adjustment accuracy, and documentation excellence. You will guide the transition from a retrospective coding model to one that strengthens clinical documentation and coding performance.

Responsibilities

• Provide leadership and operational oversight for a team of IPA Consultative Coders within an assigned region
• Accountable for regional coding performance, provider engagement, and risk adjustment outcomes
• Align coding operations with market-specific provider needs, growth strategies, and membership trends
• Partner with Provider Engagement leadership to ensure coordinated support and a consistent provider experience
• Collaborate with STARS leaders and champions to identify STARS gaps and deficiencies
• Lead implementation of the Consultative Coding Model, transitioning from retrospective workflows to longitudinal provider support
• Ensure delivery of: Quarterly provider chart reviews, Real-time coding support through a daily helpdesk, Provider education on coding accuracy and documentation standards
• Analyze trends, triage, and answer questions in real-time
• Research and interpret correct coding guidelines and internal business rules to respond to inquiries and issues
• Increase adoption and optimization of coding tools, including APD 2.0, Stellar, Healow, and MRA 4.0 (POCA)

Requirements

• Bachelor's Degree or 5+ years of relevant risk adjustment coding experience within a healthcare setting
• 3+ years of leadership or management experience
• Certified Professional Coder (CPC) or equivalent certification (RHIA, RHIT, CRC or CCS)

Preferred Qualifications

• Expertise in risk adjustment, HCC coding, and CMS guidelines
• Experience in provider-facing coding education, documentation improvement, or clinical engagement
• Passionate about contributing to an organization focused on improving consumer experiences
• Experience supporting value-based care models or IPA/MSO environments
• Experience leading field-based or hybrid teams

Qualifications

• Use your skills to make an impact
• Required Qualifications: Bachelor's Degree or 5+ years of relevant risk adjustment coding experience within a healthcare setting, 3+ years of leadership or management experience, Certified Professional Coder (CPC) or equivalent certification (RHIA, RHIT, CRC or CCS)
• Preferred Qualifications: Expertise in risk adjustment, HCC coding, and CMS guidelines, Experience in provider-facing coding education, documentation improvement, or clinical engagement, Passionate about contributing to an organization focused on improving consumer experiences, Experience supporting value-based care models or IPA/MSO environments, Experience leading field-based or hybrid teams