Manager, Clinical Coding Operations in at BZ Health Management LLC

OUR PHILOSOPHY

Blue Zones Health is creating a Well-Being Services Organization that requires a complete and reliable understanding of every member. Clinical Documentation & Intelligence helps providers understand what may require attention before the encounter. Providers evaluate the member and document their clinical findings. Coding then ensures that what occurred during the encounter is accurately and completely represented in coded clinical information.

The Manager, Clinical Coding Operations builds the operational engine that makes this process reliable at scale. Post-visit coding review also creates an important learning loop: patterns identified by the coding team can reveal recurring documentation gaps, provider education needs, opportunities to improve pre-visit planning, and clinical information that may warrant broader review. The goal is therefore larger than coding individual encounters. We are building a coding operation that continually strengthens the quality and completeness of the clinical information available across Blue Zones Health.

POSITION SUMMARY

The Manager, Clinical Coding Operations leads the day-to-day coding operation within the Clinical Documentation & Intelligence function and manages the team of coders responsible for post-visit chart review, coding accuracy, documentation validation, and coding quality.

Blue Zones Health views accurate coding as an essential component of a complete and reliable clinical record. The Manager, Clinical Coding Operations ensures that conditions evaluated and documented by providers are accurately translated into coded clinical information, giving Blue Zones Health a reliable understanding of member health and supporting clinical care, population health, risk adjustment, quality improvement, and the broader Well-Being Services model.

This is a highly operational leadership role. The Manager, Clinical Coding Operations builds and manages the workflows, systems, work queues, productivity standards, quality controls, audits, staffing models, and reporting necessary to run a scalable coding operation, working closely with the Director of Clinical Documentation & Intelligence to create a continuous feedback loop between pre-visit clinical intelligence and provider education and post-visit coding and documentation review.

Budgeted Compensation: $115,000-$145,000

KEY RESPONSIBILITIES

1. 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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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
• Partner appropriately with Well-Being Services and other clinical teams when coding or documentation patterns indicate information that may warrant broader clinical review
• Maintain clear separation between coding activities and clinical decision-making, escalating clinical questions to appropriate licensed clinical leadership

8. 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

9. 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

REQUIRED QUALIFICATIONS

• Certified Risk Adjustment Coder (CRC)
• Certified Professional Medical Auditor (CPMA)
• Significant experience in Medicare Advantage, risk adjustment, value-based care, health plans, IPAs, medical groups, or similar environments
• Demonstrated expertise in ICD-10-CM coding, CMS risk-adjustment requirements, documentation standards, and coding compliance
• Experience managing and developing a team of professional coders
• Demonstrated experience building or managing post-visit chart-review workflows, coding queues, audits, provider queries, and quality-control processes
• Strong operational and systems orientation with demonstrated ability to build efficient, scalable workflows
• Experience establishing and managing coder productivity, accuracy, quality, and turnaround-time standards
• Strong analytical skills and experience using operational data to manage team performance and workflow
• Experience working with EHRs, coding platforms, work queues, and reporting systems
• Strong leadership, communication, problem-solving, and cross-functional collaboration skills

PREFERRED QUALIFICATIONS

• CPC, CCS, RHIA, RHIT, or other relevant coding credential in addition to CRC and CPMA
• Experience building or scaling a coding operation in a growing organization
• Experience with clinical documentation integrity and pre-visit planning
• Experience working closely with physicians and provider-facing clinical teams
• Familiarity with population health, clinical quality, and value-based care
• Experience implementing or optimizing technology-enabled coding workflows