Director, Diagnosis Accuracy Program

WHO IS GUIDEHEALTH? 

At Guidehealth, our mission is to enhance healthcare affordability for patients and restore the fulfillment of practicing medicine for providers. As a physician-led company, we recognize that streamlining administrative tasks and harnessing the power of predictive analytics and AI enable our partner physician practices prioritizing delivering high-quality healthcare focused on outcomes and value. 

Driven by empathy, we empower physicians to anticipate the needs of patients requiring more attention, strengthen connections between patients and physicians with virtually-embedded Healthguides, and leverage AI and analytics to proactively avoid preventable events. This approach results in increased levels of patient and practice engagement, ultimately leading to more significant positive impacts on patients. 

Join us as we put healthcare on a better path!!  

The Director plays a crucial role in the Guidehealth team, ensuring accurate and timely coding of medical diagnoses. The Director will be responsible for building and supervising a team of coders and trainers, who will enable and oversee coding processes that maintain compliance with healthcare regulations and standards. This position requires a deep understanding of medical coding practices, compliance regulations, and the ability to lead a team to ensure accurate and timely coding of medical records. The Director is a pivotal role in ensuring accurate coding practices, regulatory compliance, and effective communication. The Director will also review and reconcile reports, provide coding training within the Coding Department and back to clients/providers and perform research on coding issues along with the industry best practices on education delivery. 

WHAT YOU’LL BE DOING  

• Leading a team of medical coders.
• Providing guidance, training, and support to coding staff.
• Selecting, configuring and utilizing the output of 3rd-party software that identifies and profiles patients who have coding accuracy opportunities.
• Reviewing and analyzing medical records to assign appropriate codes, including the removal of inaccurate or outdated codes.
• Generating and reviewing coding reports to monitor and maintain coding quality.
• Performing Project training and oversight of coders assigned to project to ensure performance meets high levels of accuracy and production.
• Assisting with creation of performance improvement plan as necessary.
• Communicating to leadership any issues related to backlogs, coding, or reimbursement and makes suggestions for process improvements.
• Analyzing and evaluating provider group performance, structure, characteristics, office operations and personnel to identify the most effective approaches and strategies related to Risk Adjustment and Stars performance.
• Staying current with relevant rules, regulations, standards, and directives from regulatory agencies and third-party payers.
• Monitoring and supporting daily staff functions in all areas related to coding & reimbursement and perform other related duties as assigned or requested.
• Resolving and remediating coding-related issues and discrepancies.
• Collaborating with healthcare providers, physicians, and other stakeholders to clarify coding queries and obtain necessary documentation.
• Encouraging communication with providers to ensure coding is linked to monitoring, evaluation, and treatment of diagnosed conditions.
• Communicating coding updates, changes, and compliance requirements to the coding team.
• Compiling monthly report for leadership identifying coding risk areas, trends, and coding accuracy.
• Identifying opportunities for professional development within the coding team.
• Developing strategies to address coding-related challenges.
• Approving coder time sheets, PTO, and LOA requests.
• Building a strong relationship with the client, gaining their trust and loyalty.
• Guiding Policy and Compliance.
• Holding weekly team lead meetings updating team on client communications.
• Managing and monitoring new hire training- drive live training sessions.
• Ensuring coders have the tools they need to be successful in their role and creating documents and workflows.
• Willing to probe into technical details, and problem solve.
• Performing other duties and conducting projects as assigned.
  

WHAT YOU'LL NEED TO HAVE

• Certified through the American Academy of Professional Coders (AAPC) or equivalent.
• CRC required
  
• Prior leadership experience in a medical coding environment
• Familiarity with CMS regulations for Risk Adjustment programs related to documentation and coding compliance for both Inpatient and Outpatient.
• Strong understanding of primary care coding, workflows, and industry struggles/standards
• Direct experience with industry-leading EHRs (Epic and Cerner highly desired)
• Experience with agile-Coding Platforms, AI Tools, and Analytics
• Highly analytical and enjoys working with data
• Experience as mentor, coach or trainer
• Adherence to a moral and ethical framework in approaching work and servicing clients
• Strong leadership skills with a dedication to driving and achieving results
• Ability to work independently but also as part of a team environment
• Must be self-motivated, highly organized, and detailed oriented
• Excellent time management and ability to work on multiple projects simultaneously while monitoring deadlines and identifying resource conflicts
• Ability to establish and maintain effective working relationships with employees, clients, and vendors (to the extent applicable).
• Ability to travel as needed (10%-25%)
  

WHAT WE WOULD LOVE FOR YOU TO HAVE

• CPC (preferred)
• Bachelor’s Degree in business or healthcare field; In lieu of degree, years of experience considered

COMPENSATION 

Guidehealth’s compensation structure includes more than just base salary. We believe in providing world-class benefits including comprehensive medical, dental, and vision plans, long and short-term disability, life insurance, and a 401k plan with a generous match. Our paid time off program includes paid holidays and flexible time that focuses on meeting the demands of the position and our clients, while providing the balance that our employees need. 

The base pay range for this role is between $120,000.00 to $150,000.00 per year, paid bi-weekly per our standard payroll practices. Final base pay decisions are dependent upon a variety of factors which may include, but are not limited to: skill set, years of relevant experience, education, location, and licensure/certifications. 

OUR COMMITMENT TO EQUAL OPPORTUNITY EMPLOYMENT 

Diversity, inclusion, and belonging are at the core of Guidehealth’s values. We are an equal opportunity employer. We enthusiastically accept our responsibility to make employment decisions without regard to race, religious creed, color, age, sex, sexual orientation and identity, national origin, citizenship, religion, marital status, familial status, physical, sensory, or medical disability, Family and Medical Leave, military or veteran status, pregnancy, childbirth or other related medical conditions, or any other classification protected by federal, state, and local laws and ordinances. Our management is fully dedicated to ensuring the fulfillment of this policy with respect to hiring, placement, promotion, transfer, demotion, layoff, termination, recruitment advertising, pay, and other forms of compensation, training, and general treatment during employment.  

This position is responsible for following all Security policies and procedures in order to protect all PHI under Guidehealth’s custodianship as well as Guidehealth Intellectual Properties.  For any security-specific roles, the responsibilities would be further defined by the hiring manager.