Director, Quality, Clinical Coding and Documentation

Location: Hybrid in the Twin Cities metro, Minnesota, with regular in-person time across clinic sites; remote work is available with travel into the market as needed.

Company

hirify.global provides relationship-centered primary care designed for women aged 65 and older, serving patients through five clinics across the Twin Cities metro.

What you will do

• Own HEDIS and Medicare Advantage Star Ratings strategy, targets, gap closure, supplemental data, NCQA submissions, and payer reporting.
• Lead prospective and retrospective risk adjustment programs under CMS-HCC V28, including HCC capture, recapture, RAF accuracy, and suspect-condition closure.
• Build and manage the clinical documentation integrity program, including compliant provider queries, chart review, documentation standards, and problem-list stewardship.
• Direct coding audits, RADV readiness, payer audit responses, appeals, remediation, and compliance with CMS and ICD-10-CM requirements.
• Develop clinician education, EHR workflows, quality and coding prompts, vendor partnerships, dashboards, and root-cause analytics.
• Hire and lead a combined team of quality staff, certified coders, CDI specialists, and clinician educators while creating scalable processes for future markets.

Requirements

• Bachelor’s degree in health information management, nursing, healthcare administration, or a related field; equivalent experience may be considered.
• Active coding certification such as CPC, CRC, CCS, CCS-P, RHIA, or RHIT; CRC is strongly preferred.
• Seven or more years of progressive experience in medical coding, risk adjustment, or clinical documentation integrity, including at least three years in leadership or program ownership.
• Deep knowledge of CMS-HCC risk adjustment, including the V24-to-V28 transition, HEDIS, Medicare Advantage Star Ratings, NCQA specifications, and CMS methodology.
• Experience building or substantially rebuilding a risk adjustment or CDI program, responding to RADV or payer audits, and conducting medical-record defensibility reviews.
• Ability to educate and influence physicians and advanced practice clinicians, with fluency in EHR systems and reporting tools.

Nice to have

• Experience in value-based, capitated, or full-risk primary care serving Medicare Advantage or senior populations.
• Clinical background as an RN or LPN, CDI certification, or formal quality-improvement training.
• Experience with CAHPS, HOS, patient experience improvement, high-growth multi-site organizations, geriatric care, or women’s health.

Culture & Benefits

• Mission-driven care model focused on improving health outcomes and experiences for older women.
• Collaborative work across quality, clinical operations, patient experience, population health, finance, actuarial, compliance, legal, and payer teams.
• Hybrid work environment with occasional travel between clinics and limited travel for conferences, payer meetings, or new market launches.
• Responsibility for maintaining the confidentiality of protected health information and following compliance policies and procedures.