Manager, Clinical Coding Operations
Coding Operations Leadership
Lead the day-to-day coding operation and manage the team of coders responsible for coding review, documentation validation, and related coding activities.
Build, implement, and continuously improve coding workflows, work queues, prioritization rules, turnaround standards, and operational controls.
Manage coding inventory and workload to ensure work is completed accurately and within established service levels.
Develop staffing and capacity models that allow the coding function to scale with membership, provider, and encounter growth.
Establish standard operating procedures and ensure consistent execution across the coding team.
Post-Visit Coding & Chart Review
Oversee post-visit review to ensure diagnoses and coded information accurately reflect provider documentation and applicable coding standards.
Establish workflows for identifying incomplete, inaccurate, unsupported, or potentially missed coding and documentation opportunities.
Ensure appropriate provider clarification or query processes are followed when documentation does not support definitive coding.
Maintain clear documentation and audit trails supporting coding decisions, corrections, and provider queries.
Ensure identified issues are resolved within established turnaround times.
Coding Team Leadership & Performance
Recruit, onboard, train, supervise, and develop a high-performing team of coders.
Establish clear individual and team expectations for productivity, accuracy, quality, turnaround time, and compliance.
Monitor coder performance through dashboards, audits, quality reviews, and regular performance discussions.
Provide coaching, education, and corrective action when performance falls below established standards.
Match work appropriately to coder experience and competency and ensure the team maintains required knowledge and credentials.
Coding Quality, Audit & Compliance
Establish and maintain coding quality-assurance and audit programs that ensure coding is accurate, complete, compliant, and supported by the medical record.
Ensure coding practices comply with ICD-10-CM, CMS, health plan, and applicable regulatory requirements.
Conduct routine and targeted audits based on identified risk, provider or coder patterns, and quality findings.
Identify root causes of coding errors and implement corrective actions, education, or workflow improvements.
Maintain operational readiness for health plan, internal, and regulatory audits.
Coding Systems & Workflow Optimization
Own the operational design of coding work queues, routing rules, systems, and workflows from completed encounter through final coding review and resolution.
Partner with technology teams to automate appropriate portions of coding workflow and reduce unnecessary manual work without compromising quality.
Develop dashboards providing real-time visibility into inventory, backlog, productivity, turnaround time, quality, and exceptions.
Identify workflow bottlenecks and implement practical solutions that improve efficiency and scalability.
Ensure coding technology and workflows support the broader Clinical Documentation & Intelligence strategy.
Clinical Documentation & Intelligence Partnership
Partner closely with the Director of Clinical Documentation & Intelligence to create a continuous feedback loop between pre-visit clinical intelligence and post-visit coding review.
Identify recurring provider documentation gaps, missed opportunities, and coding patterns, and provide structured feedback to inform provider education and pre-visit planning.
Support development of documentation standards, educational priorities, and provider-specific interventions based on actual post-visit findings.
Measure whether pre-visit planning and provider education reduce recurring post-visit documentation deficiencies.
Maintain clear accountability between the Director's clinical intelligence, provider education, and documentation strategy responsibilities and the Manager's coding operations, production, quality, and team-management responsibilities.
Clinical Management & WBS Partnership
Provide aggregate coding and documentation insights that may help Clinical Documentation & Intelligence and Clinical Management identify emerging patterns, information gaps, or opportunities for earlier intervention.
Partner with Well-Being Services to draw on their trusted, ongoing member relationships in support of coding and documentation quality — including helping close information gaps, confirming member health status, and connecting members back to providers when additional evaluation or documentation is needed.
Support the organization's ability to use reliable coded clinical information for population health, quality improvement, chronic disease management, and lifestyle-informed care.
Maintain clear separation between coding activities and clinical decision-making, escalating clinical questions to appropriate licensed clinical leadership.
Coding Issue & Denial Management
Monitor coding-related denials, corrections, and other downstream issues to identify recurring root causes.
Establish efficient workflows for investigating and resolving coding-related issues.
Use findings to improve coding practices, coder training, provider documentation, and Clinical Documentation & Intelligence workflows.
Partner with appropriate operational teams to prevent recurrence and ensure lessons learned are incorporated into the broader coding operation.
Data, Reporting & Continuous Improvement
Establish and maintain operational reporting for coding inventory, productivity, accuracy, quality, turnaround times, queries, audits, and exceptions.
Analyze coding performance and documentation patterns to identify opportunities for operational improvement.
Provide the Director of Clinical Documentation & Intelligence with regular visibility into coding performance, risks, capacity, and emerging trends.
Use data to continuously improve workflows, staffing, training, quality controls, and technology.
Build an operating culture characterized by accuracy, accountability, transparency, and continuous improvement.