• conducts quality assurance audits of medical records and ICD-9/10 diagnosis codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) and other government agencies • optimizes the effectiveness of the offshore coding (post-visit) team • analyzes the performance of the offshore coding team and creates strategies to maximize associate output • cultivates relationships with onshore and offshore coding teams including leaders • serves as liaison and primary point of contact with the offshore (vendor) leaders • advises coding leaders to develop functional strategies (often segment specific) on matters of significance • develops strategies for continuous improvement of offshore coding processes and quality in partnership with Coding Operational Excellence and Regional Coding Leaders • partners with analytics to develop quality assurance program on post-visit reviews • analyzes trends and shares results with coding leaders/teams • monitors quality and addresses performance gaps • researches and interprets correct coding guidelines and internal business rules to respond to inquiries and issues • may participate in coder education programs on coding compliance • follows state and federal regulations as well as internal policies and guidelines while analyzing coding information and medical records • partners with coding teams (consultative coders) on the special handling of Mergers & Acquisitions • leads Special Projects for onshore and offshore coding teams • participates in chart reviews to identify educational opportunities • conducts research as needed • participates in Payer calls/chart reviews • may participate in provider education programs on coding compliance • exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision

• Lead end-to-end **IAM program delivery**, ensuring scope, timelines, budget, and quality targets are met. • Drive implementation and enhancement of IAM platforms such as **Okta, SailPoint**, and broader IAM ecosystems. • Manage **audit, compliance, and regulatory requirements**, including controls validation, audit readiness, and reporting. • Ensure alignment with **security principles, IAM best practices, and risk management frameworks**. • Coordinate closely with **network, infrastructure, and security teams** for seamless IAM integrations. • Execute programs using **Agile/Scrum methodologies**, managing sprints, backlogs, and delivery tracking via **Jira**. • Lead **change management** initiatives to introduce IAM process and system changes with minimal business disruption. • Act as a primary point of contact for **business, IT, and security stakeholders**, ensuring alignment and clear communication. • Manage **global, distributed teams** across multiple time zones. • Prepare and maintain **compliance documentation, governance artifacts, and executive-level reports**.

• Facilitate successful implementation of Medicaid health plan operations programs by coordinating with cross-functional teams • Enhance operational efficiency, ensure compliance with regulatory standards, and contribute to overall healthcare operations success • Assist in the management of stakeholder relationships and establish communication channels regarding claims payment, contract or benefit setup • Collect, analyze, and interpret operational data to identify trends and insights for decision-making and improvements • Analyze operational issues, provider complaints, and propose solutions • Apply knowledge of medical coding and billing to ensure accurate claims processing • Review and analyze complex claim documentation and assess policy coverage • Identify potential risks that could impact health plan operations and develop proactive mitigation plans • Ensure program deliverables meet quality standards and comply with relevant regulations and best practices • Implement change management strategies during program implementation

• Interacts extensively with the behavioral health leadership and cross functional associates to develop and implement long range behavioral health program strategies • Serves as project manager for projects and initiatives around integration both internally and externally with providers • Directs and facilitates behavioral health clinical training programs for associates, and external behavioral/ medical provider community • Assists with BH program and services development of policy and procedure, clinical criteria, work flows and other behavioral health documentation and product development activities • Improves quality of behavioral health product by driving cross functional initiatives • Utilizes data to identify and manage change necessary to achieve performance improvement • Communicates and educates associates on behavioral health strategy • Develops behavioral health clinical educational materials, and performs provider behavioral health education • Works to develop and enhance relationships within the provider community