• Develop and operate Coding Review workflows across pre-pay and post-pay programs • Perform claim review directly to support volume, validate workflows, and ensure early consistency • Oversee daily review execution, including work allocation, throughput, turnaround time, and issue resolution • Identify operational gaps and implement process improvements within established policies and procedures • Develop and maintain the Coding Review training program, including onboarding materials, reference guidance, and ongoing education • Ensure reviewers are trained to apply Coding Review guidelines consistently • Support reviewer onboarding and ongoing skill development • Develop and run the Coding Review quality assurance program, including audits, calibration, and feedback loops • Conduct quality audits and calibration activities • Monitor quality trends, identify root causes, and implement corrective actions • Serve as an escalation point for complex or ambiguous reviews • Support guideline clarification and workflow validation through direct review experience • Build and manage the Coding Review team, including hiring, onboarding, coaching, and performance management • Provide day-to-day guidance to reviewers within established company policies and processes • Develop detailed work plans and timelines to meet operational objectives • Provide execution level operational and clinical support during Coding Review implementations • Respond to customer questions related to review workflows, guideline application, and quality processes • Support customer confidence by clearly explaining Coding Review execution and quality processes