Cano Health
Overview
Sr. Manager, Coding Quality & Vendor Oversight role at Cano Health. Oversees the quality and compliance of outsourced medical coding (post-visit) vendors, including evaluating nearshore and offshore teams’ performance, overseeing vendor audits, implementing process improvements, and ensuring compliance with Medicare, Medicaid, and commercial payer requirements. Essential Duties & Responsibilities
Lead and monitor third-party medical coding vendors for adherence to contracts, SLAs, and coding standards. Serve as the primary liaison between the organization and external coding partners. Conduct regular vendor performance reviews to assess coding accuracy, timeliness, and compliance. Oversee audits of CPT, ICD-10-CM, and HCPCS codes related to outpatient primary care, preventive services, pediatric visits, and chronic care management. Ensure vendor coding aligns with CMS (Medicare/Medicaid), state-specific Medicaid policies, and commercial payer rules (e.g., HEDIS, EPSDT). Monitor for potential issues such as upcoding, under coding, and incorrect use of E/M or preventive service modifiers. Track key metrics including vendor coding accuracy, turnaround time, denial rates, and audit findings. Provide detailed reports and insights into vendor performance and coding trends. Collaborate with vendors to implement corrective actions and training programs based on audit results and regulatory updates. Work with clinical, billing, and compliance teams to support accurate documentation and code capture. Stay current with CMS guidelines, Medicaid billing policies (state-specific), and commercial payer coding changes. Strong knowledge of CMS, Medicaid, and commercial payer coding guidelines. Experience auditing E/M, well visits, sick visits, immunizations, and chronic disease management coding. Ensure vendor compliance with policies affecting fee-for-service, preventive care billing, vaccine coding, and telehealth services. Support data audits, regulatory reporting, and HIPAA compliance efforts. Monitor data quality metrics and lead remediation efforts for anomalies or inconsistencies. Education & Experience
Bachelor’s degree in health information management, Nursing, Healthcare Administration, or related field. 5-7 years of relevant experience 2+ years in a leadership or vendor oversight role RHIA, RHIT, CCS, CPMA, CPC Certification Knowledge, Skills & Proficiencies
Comprehensive knowledge of all Microsoft Office applications, including Word, Excel, and PowerPoint Ability to communicate effectively and sensitively with team members in stressful situations Strong business acumen, strategic thinking, and critical thinking skills Excellent verbal and written communications skills with the ability to communicate, present, and influence at all levels of an organization Ability to work in a rapidly changing, matrixed environment Expertise in CPT, ICD-10-CM, HCPCS, and outpatient documentation guidelines Proficient in EHR systems (e.g., eCW, Athena, NextGen) and coding tools (e.g., 3M, EncoderPro) Strong analytical, problem-solving, and communication skills Knowledge of HEDIS measures Key Performance Metrics: Vendor coding accuracy rate, SLA compliance, reduction in claim denials, corrective action implementation, audit pass rate Physical Requirements
This position works under usual office conditions. Requires working at a personal computer and being on the phone for extended periods. Ability to stand, sit, walk, and occasionally climb. May require extended and flexible hours and weekends. Physical demands include lifting up to 50 lbs. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. Work Conditions
Must be able to perform essential functions such as typing, standing, sitting, stooping, and occasionally climbing. Travel Requirements
Yes — 0-25%. Flexibility to travel to clinical sites as needed. Tools & Equipment Used
Computer and peripherals, standard and customized software applications and tools, and usual office equipment. Disclaimer
The duties and responsibilities described above are designed to indicate the general nature and level of work performed by associates within this classification. It is not designed to contain, or be interpreted as, a comprehensive inventory of all duties, responsibilities, and qualifications required of associates assigned to this job. Cano Health is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law. Seniority level
Mid-Senior level Employment type
Full-time Job function
Quality Assurance Industries
Hospitals and Health Care
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Sr. Manager, Coding Quality & Vendor Oversight role at Cano Health. Oversees the quality and compliance of outsourced medical coding (post-visit) vendors, including evaluating nearshore and offshore teams’ performance, overseeing vendor audits, implementing process improvements, and ensuring compliance with Medicare, Medicaid, and commercial payer requirements. Essential Duties & Responsibilities
Lead and monitor third-party medical coding vendors for adherence to contracts, SLAs, and coding standards. Serve as the primary liaison between the organization and external coding partners. Conduct regular vendor performance reviews to assess coding accuracy, timeliness, and compliance. Oversee audits of CPT, ICD-10-CM, and HCPCS codes related to outpatient primary care, preventive services, pediatric visits, and chronic care management. Ensure vendor coding aligns with CMS (Medicare/Medicaid), state-specific Medicaid policies, and commercial payer rules (e.g., HEDIS, EPSDT). Monitor for potential issues such as upcoding, under coding, and incorrect use of E/M or preventive service modifiers. Track key metrics including vendor coding accuracy, turnaround time, denial rates, and audit findings. Provide detailed reports and insights into vendor performance and coding trends. Collaborate with vendors to implement corrective actions and training programs based on audit results and regulatory updates. Work with clinical, billing, and compliance teams to support accurate documentation and code capture. Stay current with CMS guidelines, Medicaid billing policies (state-specific), and commercial payer coding changes. Strong knowledge of CMS, Medicaid, and commercial payer coding guidelines. Experience auditing E/M, well visits, sick visits, immunizations, and chronic disease management coding. Ensure vendor compliance with policies affecting fee-for-service, preventive care billing, vaccine coding, and telehealth services. Support data audits, regulatory reporting, and HIPAA compliance efforts. Monitor data quality metrics and lead remediation efforts for anomalies or inconsistencies. Education & Experience
Bachelor’s degree in health information management, Nursing, Healthcare Administration, or related field. 5-7 years of relevant experience 2+ years in a leadership or vendor oversight role RHIA, RHIT, CCS, CPMA, CPC Certification Knowledge, Skills & Proficiencies
Comprehensive knowledge of all Microsoft Office applications, including Word, Excel, and PowerPoint Ability to communicate effectively and sensitively with team members in stressful situations Strong business acumen, strategic thinking, and critical thinking skills Excellent verbal and written communications skills with the ability to communicate, present, and influence at all levels of an organization Ability to work in a rapidly changing, matrixed environment Expertise in CPT, ICD-10-CM, HCPCS, and outpatient documentation guidelines Proficient in EHR systems (e.g., eCW, Athena, NextGen) and coding tools (e.g., 3M, EncoderPro) Strong analytical, problem-solving, and communication skills Knowledge of HEDIS measures Key Performance Metrics: Vendor coding accuracy rate, SLA compliance, reduction in claim denials, corrective action implementation, audit pass rate Physical Requirements
This position works under usual office conditions. Requires working at a personal computer and being on the phone for extended periods. Ability to stand, sit, walk, and occasionally climb. May require extended and flexible hours and weekends. Physical demands include lifting up to 50 lbs. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. Work Conditions
Must be able to perform essential functions such as typing, standing, sitting, stooping, and occasionally climbing. Travel Requirements
Yes — 0-25%. Flexibility to travel to clinical sites as needed. Tools & Equipment Used
Computer and peripherals, standard and customized software applications and tools, and usual office equipment. Disclaimer
The duties and responsibilities described above are designed to indicate the general nature and level of work performed by associates within this classification. It is not designed to contain, or be interpreted as, a comprehensive inventory of all duties, responsibilities, and qualifications required of associates assigned to this job. Cano Health is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law. Seniority level
Mid-Senior level Employment type
Full-time Job function
Quality Assurance Industries
Hospitals and Health Care
#J-18808-Ljbffr