Director of MRA Coding and Clinical Documentation

Valora Medical Group is a rapidly growing, innovative primary care organization committed to delivering high-quality, patient-centered healthcare. Our dedicated team of providers and professionals strives to treat every patient like family. We understand that exceptional care and outstanding service are only possible through the contributions of an empowered and collaborative team.

As the Director of Medical Risk Adjustment (MRA) and Clinical Documentation, you will play a key leadership role in shaping and executing Valora’s coding and documentation strategy. This is a hands-on leadership position responsible for overseeing internal risk coding operations, ensuring compliance with CMS/HHS guidelines, and driving provider performance through education and quality initiatives.

The ideal candidate will bring deep experience in medical risk adjustment, clinical documentation, and regulatory compliance, along with a strong commitment to fostering a high-performing, collaborative team culture. This individual will work cross-functionally with Care Management, Clinical Operations, Providers, and Leadership to optimize coding accuracy and improve risk-adjusted revenue performance.

Due to being a fast-growing company, we highly prefer onsite collaboration, but we will consider hybrid.

Essential Duties and Responsibilities:

Leadership & Operations

• Direct day-to-day operations of the MRA and Clinical Documentation team.
• Manage hiring, coaching, performance management, and professional development of team members.
• Foster a culture rooted in compliance, integrity, accountability, and Valora’s Core Behaviors.

Audit & Compliance

• Oversee risk adjustment audit processes, including medical record retrieval and validation of diagnosis codes.
• Ensure compliance with CMS, HHS, and other federal/state regulations.
• Monitor policy changes and lead the implementation of updated protocols and training.

Provider Engagement & Education

• Design and implement provider education strategies to improve documentation and coding accuracy.
• Track provider performance and lead interventions for those performing below benchmarks.
• Develop corrective action plans and deliver targeted education as needed.

Coding Operations

• Manage a team of internal coders and clinicians focused on accurate and timely Risk Adjustment coding.
• Lead quality assurance efforts on virtual coding programs to ensure coding integrity.
• Monitor coding productivity and accuracy metrics, reporting key performance indicators to leadership.

Cross-Functional Collaboration

• Partner with Clinical Operations, Compliance, and Care Management teams to align strategies.
• Serve as the subject matter expert for MRA, providing insight and recommendations to improve financial and clinical outcomes.

Additional Expectations

• Act professionally and treat co-workers and leadership with respect.
• Motivate and empower the team to maximize outcomes and maintain a positive work environment.
• Adheres to and models company standards, processes, and protocols.
• Lead by example and champion Valora’s vision, mission, and values
• Other duties as assigned.

Education/Qualifications:

• Bachelor's Degree in Healthcare Administration, Business Administration, or Management Substitutions
• Master's Degree in preferred
• Bilingual in English and Spanish is highly preferred
• 7+ years’ experience in management, specifically in the healthcare industry
• 5+ years’ experience with MRA Coding and Clinical Documentation
• Knowledge of EMR systems - eClinicalWorks (eCW) experience is required
• Proficient in Microsoft Office 365 (Outlook, PowerPoint, Excel, Word)
• Understanding of and adherence to expectations under CMS Fraud/Waste Abuse, OSHA, and HIPAA
• Must have effective written, verbal communication, and interpersonal skills
• Ability to complete assigned duties in a timely and proficient manner
• Ability to communicate with others effectively in a concise manner, in order to bring issues effectively to a resolution
• Ability to establish working relationships, resolve interpersonal conflicts, and apply basic staff etiquette in dealing with others
• Ability to handle confidential information with discretion
• Strong analytical skills with attention to detail
• Ability to learn new procedures and adapt quickly to change
• Innovative, motivated, organized, and team player
• Follow through with commitments
• Ability to work independently
• Proactive and self-starter.

EXPERIENCE

Required

• 7 - 10 years in the Healthcare Industry
• 5 - 7 years in Management
• 5 - 7 years in Risk Revenue

LICENSES AND CERTIFICATIONS

Required

• AAPC, Certified Professional Coder (CPC)

Highly Preferred

• AAPC, Certified Risk Adjustment Coder (CRC)

Skills:

• CMS Regulations
• EHR (eClinicalWorks)

EEO Statement: Valora Medical Group, LLC is an equal opportunity employer and does not discriminate on the basis of race, color, religion, creed, sex, national origin, age, disability, pregnancy status, sexual orientation, gender identity, veteran status, marital status, genetic information, citizenship status, or other status protected by law. In compliance with the Immigration Reform and Control Act of 1986, we will hire only U.S. citizens and aliens lawfully authorized to work in the United States.