[Hiring] Director of Quality, Clinical Coding and Documentation @Herself Health

Role Description

The Director, Quality, Clinical Coding and Documentation owns the two functions that determine whether Herself Health succeeds under value-based contracts: the quality of care we deliver and can demonstrate, and the accuracy of the clinical documentation and coding that describes our patients. This is a build-and-run role.

• Design and lead the programs that drive HEDIS and Star Ratings performance.
• Ensure documentation accurately reflects the complexity of the women we serve.
• Keep coding compliant and defensible under audit.
• Hold accountability for quality measure performance end to end.
• Own the full arc of risk adjustment and clinical documentation integrity (CDI).

Key Responsibilities

• Quality Program Ownership:
  • Own HEDIS and Medicare Advantage Star Ratings performance.
  • Prioritize measures for women 65+ including Breast Cancer Screening, Colorectal Cancer Screening, and others.
  • Lead gap closure operations end to end.
  • Direct the quality team and partner with clinic leadership.
  • Own supplemental data strategy and NCQA HEDIS submission.
  • Manage the annual quality calendar.
  • Serve as the primary point of contact with health plan partners.
  • Ensure appropriate application of measure exclusions.
  • Partner with patient experience and clinical operations teams.
  • Stay current on NCQA specification changes and CMS Star Ratings updates.
• Integration of Quality, Risk Adjustment, and Documentation:
  • Own coding-side accuracy of quality measure capture.
  • Design annual wellness visits and comprehensive assessments.
  • Deliver a coherent set of expectations to clinicians.
  • Analyze gap closure and measure performance alongside coding accuracy data.
• Risk Adjustment Program Ownership:
  • Own the end-to-end risk adjustment strategy.
  • Lead the organization’s operating model under CMS-HCC V28.
  • Establish and monitor RAF accuracy targets.
  • Partner with finance and actuarial colleagues.
  • Oversee annual wellness visit documentation workflows.
• Clinical Documentation Integrity:
  • Design, launch, and lead the CDI program.
  • Develop compliant provider query practices.
  • Establish documentation standards supporting MEAT/TAMPER criteria.
  • Drive problem list stewardship across the organization.
• Coding Accuracy, Compliance, and Audit Defense:
  • Own the internal coding audit program.
  • Lead RADV readiness and response.
  • Serve as subject matter expert for payer audits.
  • Ensure compliance with CMS risk adjustment guidance.
  • Establish and enforce a “delete what isn’t supported” standard.
• Clinician Education and Enablement:
  • Build and deliver a clinician education curriculum.
  • Provide individualized clinician feedback.
  • Onboard new physicians and advanced practice providers.
  • Serve as a resource for clinical documentation questions.
• Technology, Workflow, and Analytics:
  • Partner with clinical informatics and IT to optimize EHR templates.
  • Evaluate, select, and manage technology vendors.
  • Build the reporting infrastructure.
  • Reconcile submissions and monitor encounter data flow.
• Leadership and Team Building:
  • Hire, develop, and lead a combined team.
  • Establish productivity and quality standards for the team.
  • Build the function to scale as Herself Health grows.
  • Represent quality, coding, and documentation performance.

Qualifications

• Bachelor’s degree in health information management, nursing, healthcare administration, or a related field.
• Active coding certification — CPC, CRC, CCS, CCS-P, RHIA, or RHIT.
• Seven or more years of progressive experience in medical coding, risk adjustment, or clinical documentation integrity.
• Deep working knowledge of the CMS-HCC risk adjustment model.
• Demonstrated experience building or rebuilding a risk adjustment or CDI program.
• Direct experience with RADV or payer audit response.
• Strong command of the ICD-10-CM Official Guidelines for Coding and Reporting.
• Demonstrated ownership of HEDIS and Medicare Advantage Star Ratings performance.
• Working knowledge of NCQA HEDIS technical specifications.
• Proven ability to teach and influence clinicians.
• Fluency with EHR systems and reporting tools.

Nice-to-have Qualifications and Skills

• Experience in value-based, capitated, or full-risk primary care.
• Clinical background (RN or LPN) in addition to coding credentials.
• CDI certification — CDIP, CCDS, or CCDS-O.
• Experience in a high-growth or multi-site organization.
• Experience with CAHPS, HOS, or patient experience improvement work.
• Formal quality improvement training or certification.
• Experience serving geriatric or women’s health populations.

Core Competencies

• Integrity under pressure.
• Clinical credibility.
• Systems thinking.
• Operational follow-through.
• Teaching orientation.
• Builder’s bias.
• Mission alignment.

Work Environment and Requirements

• Hybrid role based in the Twin Cities metro.
• Occasional travel between clinic locations.
• Standard office and clinic environment with prolonged periods of computer work.
• Must maintain confidentiality of protected health information.

Equal Opportunity

Herself Health is an equal opportunity employer. We are committed to building a team that reflects the communities we serve and to providing an environment free from discrimination and harassment.