Director, Medical Coding & Audit

CodaMetrix is revolutionizing Revenue Cycle Management with its AI-powered autonomous coding solution, a multi-specialty AI-platform that translates clinical information into accurate sets of medical codes. CodaMetrix’s  autonomous coding drives efficiency under fee-for-service and value-based care models and supports improved patient care. We are passionate about getting physicians and healthcare providers away from the keyboard and back to clinical care.

Overview

The Director, Medical Coding & Audit leads the Medical Coding & Audit Team, reporting to the Chief Customer Officer. The Medical Coding & Audit team is responsible for model quality, outsourced vendor auditing and quality of production coding to support the CMX Quality Matrix. 

The Director, Medical Coding & Audit is responsible for overseeing a team of certified medical coders and managing outsourced vendor resources, with a primary focus on auditing production coding and evaluating machine learning (ML) model performance. They will ensure their team perform at an ideal coding level to train and optimize the machine learning models. The team will also be responsible for annotating cases to support further model training and improve automation accuracy across various medical specialties.

Responsibilities

• Team Leadership: Lead, mentor, and manage a team of certified medical coders who will focus on coding visits to an ideal coding level for machine learning model training and auditing.
• Vendor Management: Oversee outsourced coding vendors, ensuring their outputs align with internal standards for both coding accuracy and machine learning model improvement.
• Audit and Quality Assurance: Conduct thorough audits of production coding to maintain accuracy, ensure compliance, and monitor machine learning model performance.
• ML Model Support: Collaborate with AI&MLand Engineering teams to ensure coders annotate cases appropriately to enhance the training and optimization of machine learning models.
• Process Optimization: Continuously refine and streamline coding processes to improve productivity, accuracy, and machine learning performance.
• Specialty Focus: Direct coding efforts across multiple specialties, including Radiology, Pathology, Surgery, Endoscopy, Bedside Visits, Emergency Department (ED), Cardiology, and Hierarchical Condition Categories (HCC), to support the automation and prediction capabilities of our ML models.
• Data Analysis & Reporting: Utilize data analysis tools to monitor team performance and coding quality, generating insights that drive process improvements and model effectiveness.
• Performance Metrics: Develop and implement performance metrics for both human coders and machine learning models, ensuring the team meets goals related to accuracy, productivity, and compliance.
• Regulatory Compliance: Stay current with industry regulations, coding standards (ICD, CPT, HCPCS), and compliance requirements, ensuring your team adheres to these standards.  Define CMX way and advocate with our customers on best practices
• Cross Team Collaboration:  Cultivate strong peer relationships to continue the advancement of coding quality standards across the organization.

Requirements  

• Required
  • Minimum of 5+ years of experience in medical coding, including team management and vendor oversight.
  • Proven expertise in auditing coding processes and ensuring high accuracy, particularly in a production environment.
  • Strong understanding of data analysis tools and their application in monitoring both team performance and machine learning model effectiveness.
  • Strong people management and leadership skills with a focus on mentoring and developing talent.
  • Excellent communication skills and the ability to effectively collaborate with cross-functional teams, including data science, engineering, and clinical informatics.
• Preferred
  • Familiarity with machine learning model training, data annotation, and the role of coders in enhancing model performance.
  • In-depth knowledge of coding standards (ICD, CPT, HCPCS) and experience in relevant specialties such as Radiology, Pathology, Surgery, Endoscopy, Bedside Visits, ED, Cardiology, HCC, DRG and facility coding.
  • Experience in process optimization, efficiency improvements, and driving performance within medical coding teams.
  • Certification in medical coding (e.g., CPC, CCS)

What CodaMetrix can offer you:

Learn more about our full-time employee benefits and how we take care of our team.

• Health Insurance: We cover 80% of the cost of medical and dental insurance and offer vision insurance
• Retirement: We offer a 401(k) plan that eligible employees can contribute to one month after their first day
• Flexibility: We have a generous Paid Time Off policy, which is managed but not limited, so you can take the time you need to relax and rejuvenate
• Learning: All new hires complete our 7-week Onboarding Program where they learn about our company and each of our departments through live sessions hosted by a variety of our leaders
• Development: We provide annual performance evaluations and prioritize working with employees on what their individual growth looks like
• Recognition: We recognize the outstanding achievements of our team through annual company awards where employees have the opportunity to nominate their peers
• Office Location: A modern open plan workspace located in the bustling Back Bay neighborhood of Boston
• Additional Employer Paid Benefits: We offer employer-paid life insurance and short-term and long-term disability insurance

Background Check Notice

All candidates will be required to complete a background check upon acceptance of a job offer.

Equal Employment Opportunity

Our company, as well as our products, are made better because we embrace diverse skills, perspectives, and ideas. CodaMetrix is an Equal Employment Opportunity Employer and all qualified applicants will receive consideration for employment.

Don’t meet every requirement? We invite you to apply anyway. Studies have shown that women, communities of color and historically underrepresented talent are less likely to apply to jobs unless they meet every single qualification. At CodaMetrix we are committed to building a diverse, inclusive and authentic workplace and encourage you to consider joining us.