Supervisor, Risk Adjustment Coding

Job Description Summary Under the direction of the Risk Adjustment Manager, the Risk Adjustment Supervisor is responsible for providing first-line supervision for the Risk Adjustment Coding Specialist. Supervisor responsibilities include but are not limited to daily supervision and monitoring of quality and productivity performance, interviewing, hiring, and any necessary discipline of staff.

This position supervises 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 supervision of department staff and provides feedback to the Risk Adjustment Manager on exceptional and/or substandard performance.

Support Manager in efforts associated with hiring, interviewing, onboarding, and recognition and discipline of staff.

Serves as a preceptor to new employees during the orientation process. Functions as a resource to existing staff for projects and daily work. Facilitates ongoing training for optimal staff functioning.

Conduct audits of Risk Adjustment Coding Specialist work to validate the accuracy and completeness of diagnosis suspects, claim submission, and/or retrospective reviews identifying and resolving any discrepancies or areas for improvement.

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.

Prepares staffing schedules to provide adequate coverage for all bodies of work.

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 helps implement 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.

Analyze MRA data to identify patterns and when requested assist in the development of interventions at the provider and region level.

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

Qualifications High school diploma or GED equivalent

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

Minimum of two (2) years coding experience directly related to Hierarchical Condition Category (HCC) coding.

Minimum of one (1) year experience in a lead/senior role Advanced knowledge of medical terminology, abbreviations, anatomy and physiology, major disease processes, and pharmacology.

Extensive knowledge of coding conventions and payment rules as they apply to medical record documentation, billing of medical services, and health care reimbursement systems.…