Director, Vendor Coding
Director I - BPM
Who We Are:
UST HealthProof is a trusted partner for health plans, offering an integrated ecosystem for health plan operations. Our BPaaS solutions manage complex admin tasks, allowing our customers to prioritize members' well-being. With our commitment to simplicity, honesty, and leadership, we navigate challenges with our customers to achieve affordable health care for all.
We have a strong global presence and a dedicated workforce of over 4000 people spread across the world.
Our brand is built on the strong foundation of simplicity, integrity, people-centricity, and leadership. We stay inspired in our goal to unburden healthcare and ensure it reaches all, equitably and effectively.
You Are:
UST HealthProof is searching for a highly skilled and experienced Director of Vendor Coding to join our growing team. The Director of Vendor Coding is responsible for overseeing coding production, ensuring quality assurance, and managing training and audit activities. Key responsibilities include directing the management of medical record coding operations across various programs and teams. The Director is responsible for continuous improvement of these programs and ensuring accuracy in vendor coding. The role will implement strategies to improve coding processes, maintain coding guidelines, and promote training needs of team members and vendors across RADV audits. The Director, Vendor Coding will meet with health plan customers to discuss their coding performance and strategy. This role will manage coding operations across multiple risk adjustment coding programs, including strategic planning, forecasting, and reporting.
The Opportunity:
As a Director of Vendor Coding at UST HealthProof, this is your opportunity to:
* Manage oversight of outsourced vendor coding activities, including
development, implementation, and refinement of risk adjustment coding workflow
* Ensure oversight of risk adjustment vendor coding (Medicare and ACA).
* Analyze vendor production and quality results to identify opportunities for
process optimization.
* Direct the management of audit activities, including internal audits and
vendor audits.
* Meet regularly with internal and external business partners to coordinate and
ensure meeting of deadlines.
* Discuss progress, coding training for certified coders, and conduct training
for items identified in meetings.
* Manage vendor coding and ensure audits meet company and program standards.
* Oversee vendor communications and client relationships.
* Coordinate communications, department/team procedures, and process
improvements.
* Maintain consistent documentation for reporting.
* Participate in vendor onboarding, contract updates, and risk adjustment
strategic initiatives.
* Review vendor reports and partner recommendations to ensure opportunities to
improve quality are identified.
* Provide coaching to staff and vendors, ensuring goals are accomplished.
* Maintain documentation for training needs and develop process guides.
* Lead the Vendor Coding team to meet and exceed goals.
* Review production and quality of work across vendors and prepare a
subject-matter report for its team.
* Train team members on identified process initiatives.
* Support VP of Coding to accomplish annual and ad-hoc tasks associated with
the population s risk adjustment coding.
* Domestic/international travel may be required.
This position description identifies the responsibilities and tasks typically associated with the performance of the position.
Other relevant essential functions may be required.
What You Need:
You bring:
* Bachelor s degree is required. Clinical license/experience with relevant
* experience may be considered in lieu of degree.
* Fifteen (15) years of experience in risk adjustment programs is required.
* Fifteen (15) years of management experience in a medical coding production
* and quality environment OR an equivalent combination of relevant experience
* that provides the necessary knowledge, skills, and abilities.
* RADV or HEDIS audit experience required.
* HEDIS abstraction or similar prior medical audit experience preferred.
* Successful completion of a medical coding licensure. Acceptable
* licenses/certifications: CPC, COC, or CRC from AAPC, or CCS or CDIP from AHIMA.
* Experience managing multiple vendors, troubleshooting within audits;
* certification is required.
* Experience managing/leading offshore vendors with 5,000+ coders.
* Ten years of offshore vendor oversight.
* Project Management certification preferred.
* Flexible schedule to meet India and offshore time zones.
* Experience in risk adjustment vendor management across Medicare, ACA
* commercial, Medicaid/RADV.
* Knowledge and commitment to meeting deadlines.
* Strong financial and operational experience across coding guidelines, medical
* record coding, medical record availability, and monitoring and auditing of
* medical documentation and coding.
* Demonstrate understanding of ICD and/or RADV audits.
* Manage and resolve escalated issues.
* Ability to lead staff and vendors in high-volume production while meeting
* deadlines.
Compensation can differ depending on factors including but not limited to the specific office location, role, skill set, education, and level of experience. UST HealthProof provides a reasonable range of compensation for roles that may be hired in various U.S. markets as set forth below.
Role Location: Remote
Compensation Range: $135,000 -$168,000 per year
Benefits
Full-time, regular employees accrue up to 16 days of paid vacation per year, receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year), 10 paid holidays, and are eligible for paid bereavement leave. They are eligible to participate in the Company's 401(k) Retirement Plan with employer matching. They and their dependents residing in the US are eligible for medical, dental, and vision insurance, as well as the following Company-paid benefits: basic life insurance, accidental death and disability insurance, and short- and long-term disability benefits. Regular employees may purchase additional voluntary short-term disability benefits, and participate in a Health Savings Account (HSA) as well as a Flexible Spending Account (FSA) for healthcare, dependent child care, and/or commuting expenses. Certain regular employees may have the potential for quarterly incentive-based bonuses and or commissions depending on role. Benefits offerings vary in Puerto Rico.
Part-time employees receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year) and are eligible to participate in the Company's 401(k) Retirement Plan with employer matching.
Full-time temporary employees receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year) and are eligible to participate in the Company's 401(k) program with employer matching. They and their dependents residing in the US are eligible for medical, dental, and vision insurance.
Part-time temporary employees receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year).
All US employees who work in a state or locality with more generous paid sick leave benefits than specified here will receive the benefit of those sick leave laws.
What We Believe
At UST HealthProof, we envision a bold future for American healthcare. Our values are the bedrock beliefs our organization holds dear. They not only define what our brand stands for but also serve as a compass guiding every action and decision.
Guiding Principles
These principles illuminate the path of 'how' we operate. They detail actions and behaviors we much embody to honor our values and achieve our goals.
Simplifying complexity underlines everything we do-this approach is what makes us unique. We come with an open mind and straightforward approach, cutting our way to the core with measurable and actionable insights.
Integrity is our currency to build relationships. We believe in being open and honest. It is only natural when we have nothing to hide. It demonstrates that we are here to do the right thing, no matter who is watching.
Everything that we do reflects our deep bonds with peers and customers. These aren't mere transactions, but transformational ties. They shape our culture and decisions, affirming that our true value lies in the lives we touch and impact.
Taking ownership is about taking initiative, being in-charge and driving things to completion. It's a brave choice to 'own' all aspects of our work, ensuring we take full responsibility for everything we handle.
Mission
A future possible only when health plans are free from administrative burdens so they can truly focus on what matters more - their members' well-being.
Equal Employment Opportunity Statement
UST HealthProof is an Equal Opportunity Employer.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other applicable characteristics protected by law. We will consider qualified applicants with arrest or conviction records in accordance with state and local laws and "fair chance" ordinances.
UST HealthProof reserves the right to periodically redefine your roles and responsibilities based on the requirements of the organization and/or your performance.
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UST
$135,000 -$168,000 per year
life insurance, vision insurance, flexible benefit account, paid holidays, sick time, 401(k), retirement plan
Dec 29, 2025