Director, Quality, Clinical Coding and Documentation

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Director, Quality, Clinical Coding and Documentation based in the United States.

This is a senior leadership opportunity responsible for integrating quality performance, clinical coding, risk adjustment, and documentation integrity across a growing healthcare organization.

The role owns the full quality lifecycle, from HEDIS and Medicare Advantage Star Ratings strategy through gap closure, reporting, supplemental data, and payer engagement.

It also leads risk adjustment and clinical documentation programs, ensuring patient conditions are accurately, compliantly, and defensibly represented in the medical record.

You will build scalable programs, workflows, analytics, education, and operational standards while keeping the experience practical for clinicians.

The position combines strategic ownership with hands-on execution, including audit readiness, compliance, technology optimization, vendor management, and team development.

You will work closely with clinical, operational, finance, analytics, compliance, and executive stakeholders in a mission-driven, high-growth environment.

This is an opportunity to shape systems that improve care quality, strengthen clinical accuracy, and ensure older women are represented fully and accurately in their healthcare records.

• Own HEDIS and Medicare Advantage Star Ratings strategy and performance, establishing annual targets, prioritizing measures, monitoring results, and driving accountability across clinics and payer relationships.
• Lead end-to-end quality gap closure, including gap identification, prioritization, outreach campaigns, scheduling strategies, standing orders, care team workflows, and closed-loop completion tracking.
• Embed quality improvement into everyday clinical operations through pre-visit planning, team huddles, point-of-care prompts, post-visit follow-up, and other scalable workflows.
• Oversee supplemental data strategy and NCQA HEDIS submissions, ensuring source data, clinical documentation, payer files, and submissions are accurate, complete, and auditable.
• Manage the annual quality calendar, including specification changes, roadmap planning, performance reviews, chart retrieval, and year-end close.
• Serve as a key point of contact for payer partners on quality performance, gap reconciliation, joint operating discussions, and quality incentive initiatives.
• Ensure quality measure exclusions are applied appropriately and supported by documented clinical circumstances rather than being used solely to improve performance rates.
• Integrate quality, risk adjustment, and documentation strategies so clinicians receive coherent expectations and patient encounters address multiple needs without unnecessary duplication.
• Own the end-to-end risk adjustment program, including prospective and retrospective coding, HCC capture and recapture, suspect-condition management, documentation priorities, and performance monitoring under CMS-HCC V28.
• Establish targets and reporting for RAF accuracy, condition recapture, suspect-condition closure, coding accuracy, and related financial and operational outcomes.
• Design and lead the clinical documentation integrity program, including compliant provider queries, chart review standards, feedback processes, documentation expectations, and problem-list stewardship.
• Direct internal coding audits, including sampling methodology, audit cadence, accuracy thresholds, root-cause analysis, corrective actions, and continuous improvement.
• Lead RADV and payer audit readiness and response activities, including medical record retrieval, documentation defensibility reviews, attestations, appeals, remediation, and external audit coordination.
• Ensure compliance with CMS risk adjustment guidance, ICD-10-CM coding standards, Medicare Advantage data validation requirements, HIPAA, applicable fraud and abuse requirements, and internal compliance policies.
• Build and deliver clinician education on documentation specificity, HCC concepts, coding requirements, query response, quality measures, and common documentation gaps relevant to older women.
• Provide individualized performance feedback and serve as a trusted resource for physicians and advanced practice clinicians on clinical documentation questions.
• Partner with clinical informatics and technology teams to optimize EHR templates, quality and coding prompts, suspecting logic, registries, and workflows that improve accuracy while minimizing clinician burden.
• Evaluate and manage quality, coding, NLP, risk adjustment, delegated coding, and outreach vendors, establishing clear service and accuracy expectations.
• Develop dashboards, scorecards, and root-cause analytics that make quality performance, care gaps, coding accuracy, and operational trends visible at organizational, clinic, and clinician levels.
• Monitor encounter data flows, payer submissions, error rates, and acceptance to ensure complete and reliable data.
• Build, hire, develop, and lead a multidisciplinary team spanning quality, coding, CDI, and clinician education, establishing productivity, quality, credentialing, and reliability standards.
• Develop scalable playbooks, training resources, policies, and procedures that can support expansion into additional markets.
• Represent quality, coding, documentation, and risk adjustment performance to executive leadership, board stakeholders, payer partners, and cross-functional teams.
• Champion an environment grounded in integrity, clinical credibility, accountability, collaboration, continuous improvement, and accurate representation of patient needs.

• Bachelor’s degree in health information management, nursing, healthcare administration, or a related field; equivalent relevant experience may be considered.