Manager, Risk Adjustment Coding

Position Summary

The Manager of Risk Adjustment Coding manages the day-to-day operations of the Risk Adjustment Coding Team. This position is responsible for the development, implementation and performance of workflows for auditing electronic medical records aimed at improving the health and well-being of patients and proper identification of Chronic Disease Conditions as well as working to create a unique data and reporting model to capture and optimize ICD-10 reporting to Payers to improve quality for our patients and reduce healthcare costs.

The incumbent is a working Manager and determines the appropriate ICD
10-CM diagnoses codes based on clinical documentation that follows the Official Guidelines for Coding and Reporting and Risk Adjustment guidelines for risk adjustment and Hierarchical Condition Categories (HCC). Risk adjustment coding relies on ICD-10-CM coding to assign risk scores to patients.

• In partnership with key stakeholders, supports management oversight of Coders and continuously works to improve people, process, and technology across the function
• Works in partnership with Value Based Care Team to manage accurate and compliant coding practices, find opportunities for documentation improvement, optimize risk adjustment processes, and support revenue cycle management
• Applies knowledge of key business drivers and the factors that improve the Risk Score Management departmental performance and anticipates business and regulatory issues and trends to identify improvements
• Actively contributes to the strategic direction for Risk Coding and collaborates with internal and external partners to lead volume and ensure adherence to agree upon SLAs
• Communicates relevant changes in performance, market trends, health care delivery systems, and legislative initiatives impacting execution of team goals to team(s)
• Establishes KPIs for Risk Coding functions; ensures the implementation of action plans where performance is not meeting expectations
• Maintains current knowledge of regulatory and compliance changes impacting Risk Coding operations, and ensures all employees are appropriately educated
• Provides guidance and oversight for Risk Coding methodology, performance, and workflows
• Identifies and solves complex, operational, or cross-functional problems using the appropriate resources within or outside the department
• Facilitates projects and conversations within BMCHS to share and develop standard processes
• Develop and implement quality improvement initiatives, including conducting regular audits, educating coders/clinicians, and monitoring KPIs for improvements
• Ensures compliance with all applicable Federal, State and/or County laws and regulations related to coding and documentation guidelines for Risk Adjustment
• Conducts reviews for clinical indicators and queries providers to capture the severity of illness of the patient
• Measures providers’ performance on important aspects of care and service
• Facilitates and coordinates reporting to leadership within the organization as requested
• Provides clear, concise and professional communication to varying audiences depending on the project and its goals
• Supports the RA Team in a positive manner with emphasis on providing excellent service to all patients, providers, internal and external customers
• Communicates to Manager and IT Department regarding defects identified in the reporting systems or database, suggests performance improvement opportunities and tracks through completion to ensure revenue capture
• Demonstrates excellent time management, attends and contributes to required meetings
• Demonstrates the ability to train new staff or provide ongoing education and training to existing staff along with regularly performing quality reviews and including feedback on opportunities for improvement to the Risk Coding team
• Additional duties as required
• Must adhere to all of BMC’s RESPECT behavioral standards

Associates Degree Required, Bachelor’s Degree Preferred

• Associates Degree Required, Bachelor’s Degree Preferred
• Coding Certification from American Academy of Professional Coders (AAPC) or American Health Information…