Risk Adjust Prgm Team Lead​/Clinical Integration

Location Detail: 100 Pearl Street Hartford (10484)

Work where every moment matters.

Every day, over 40,000 Hartford Health Care colleagues come to work with one thing in common:
Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut's most comprehensive healthcare network.

The creation of the HHC System Support Office recognizes the work of a large and growing group of employees whose responsibilities are continually evolving so that we and our departments now work on behalf of the system as a whole, rather than a single member organization.

With the creation of our new umbrella organization we now have our own identity with a unique payroll, benefits, performance management system, service recognition programs and other common practices across the system.

Reporting to the Director of Quality and Clinical Integration, the Risk Adjustment Program Team Lead serves as a coordinator and resource for the Risk Adjustment team; works with other coders to ensure that all coding reviews are completed in a timely manner; verifies accuracy of reports; completes own workload of coding reviews, and identifies training needs based on questions/guidance requests from the coding team.

The Team Lead works closely with the Director to identify opportunities to update Risk Adjustment workflows or initiate new workflows to drive network initiatives and achieve the organization's overall goals.

• Oversee the development of complex and advanced ICD-10 and Hierarchical Condition Category (HCC) coding and documentation training programs, including defining training objectives, developing training materials, and tools.
• Implement documentation and coding training programs for network providers, presenting coding and documentation education in an appropriate format across a variety of settings.
• Collaborate with clinical, operational, and financial leaders to optimize HCC coding and documentation workflows that support the HCC risk adjustment coding program across the organization, ensuring that coding practices align with CMS guidelines and other regulatory requirements.
• Review documentation available in the medical record to facilitate workflows that support the clinical picture/severity of illness/complexity of the patient care rendered to patients.
• Create "train the trainer guides" and standard work documents.
• Actively participate in and maintain coding quality and productivity benchmarks.
• Collaborate with colleagues and departments across the organization to perform retrospective and other targeted medical record reviews, ensuring documentation accuracy, evaluating clinical severity, identifying quality concerns, and supporting continuous improvement across evolving review priorities.
• Develop and implement educational programming for providers, departments, and clinic staff relating to risk coding and documentation compliance, as well as new policies and procedures.
• Stay up to date with changes in HCC coding regulations, ensuring organizational compliance, and implementing necessary updates to processes.

Perform other related duties as required

Director of Quality and Clinical Integration, ICP

• Minimum:
  Associate's degree in a health-related field or equivalent work experience
• Preferred:
  Bachelor's Degree in a health-related field or equivalent work experience

• Minimum:
• 5+ years of dedicated Risk Adjustment / HCC coding experience
• Strong knowledge of Medicare Advantage and CMS Risk Adjustment models
• Experience with:
• Pre-visit reviews
• Concurrent reviews
• Retrospective audits
• Documentation validation
• Suspect…