Manager, Risk Adjustment Coding

Job Description Summary The Risk Adjustment (RA) Manager reports to the Director of Burden of Illness (BOI). S/he performs duties to conduct the day-to-day management of the MRA Team Supervisors and team functions by communicating with other operational departments and provider offices. S/he will participate in the development, implementation, and performance of workflows for reviewing electronic medical records aimed at improving the health and well-being of patients through appropriate identification of chronic disease conditions.

This role will collaborate with all areas of the organization to ensure success of our value-based coding initiatives such as provider engagement, education, prevalence rates, documentation compliance and medical margin. He/she will support and further enhance the data and reporting model to capture and optimize ICD-10 reporting to payers to improve quality for our patients and reduce healthcare costs.

This position manages risk adjustment coding and quality assurance validation for the following programs, including but not limited to:
• Prospective medical record review
• Concurrent outpatient claim diagnosis coding
• Retrospective medical record and provider response reviews

How will you make an impact & Requirements Responsibilities Subject  matter expert for proper risk adjustment coding and CMS data validation

Provides daily management of department staff and provides feedback to the Director of BOI on exceptional and/or substandard performance.

Oversees and ensures completion of all efforts associated with hiring, interviewing, onboarding, and recognition and discipline of staff.

Execute on the continued development of provider performance measures on important aspects of care and service through data reviews and data-driven analysis.

Provides ongoing feedback to staff on areas of success and improvement opportunities.

Ensures that all members of the team are following official guidelines, policies, and standard procedures.

Counsels staff on actions required to meet minimum performance requirements.

Provides or arranges for necessary knowledge-based resources required by the department staff to meet quality and production standards.

Contributes to the reporting for reassessment of chronic conditions, provider address rates, coder variability, and other risk adjustment coding related measure trends

Participates in identifying and developing technology to enhance risk adjustment operations and accuracy

Stay updated on changes to Medicare guidelines, coding regulations, and reimbursement methodologies to ensure compliance and accuracy in coding practices.

Develop and lead coding education and training initiatives for staff to promote consistent and accurate coding practices across the organization.

Research best practices in risk adjustment coding and reviews the professional literature for coding updates, maintaining currency in coding.

Evaluates, researches, and recommends enhancements to the risk adjustment program and internal coding guidelines.

Develops and implements new workflows and policies and procedures as needed to support new and existing department initiatives, audits, and projects.

Lead work groups and manage project deliverables for department initiatives, audits, and provider communications.

Keeps department Director apprised of project activities through regular written and oral status reports. Proactively identifies risks that may hinder project success.

Qualifications Bachelor’s degree or 3 years of equivalent related work experience

Current active coding credential through AAPC or AHIMA required.
** Preference given to those with CRC designation.

Minimum of three (3) years coding experience directly related to Hierarchical Condition Category (HCC)…