Manager, Risk Adjustment Coding
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Job Description
Manager of Risk Adjustment Coding responsible for overseeing the coding team and improving workflows. Collaborating on quality healthcare initiatives and managing compliance in coding practices.
Responsibilities:
- Manage the day-to-day operations of the Risk Adjustment Coding Team.
- Responsible for the development, implementation and performance of workflows for auditing electronic medical records.
- Determine appropriate ICD10-CM diagnoses codes based on clinical documentation.
- Support management of oversight of Coders and continuously work to improve people, process, and technology.
- Collaborate with Value Based Care Team to manage accurate and compliant coding practices.
- Contribute to the strategic direction for Risk Coding and collaborate with internal and external partners.
- Establish KPIs for Risk Coding functions; ensure the implementation of action plans where performance is not meeting expectations.
- Provide guidance and oversight for Risk Coding methodology, performance, and workflows.
- Conduct reviews for clinical indicators and query providers to capture the severity of illness of the patient.
- Measure Providers’ performance on important aspects of care and service.
- Support the RA Team in a positive manner with emphasis on providing excellent service to all patients, providers, internal and external customers.
Requirements:
- Associates degree required, Bachelor’s degree preferred
- Coding Certification from American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA) required.
- Minimum of four (4) years progressive coding and/or coding leadership experience in Risk Adjustment Coding
- Experience with an Electronic Medical Record (EMR), EPIC preferred
- Knowledge of AHA coding guidelines and methodologies: HCC’s and other RA methodologies, ICD-10-CM coding guidelines, Office of Inspector General (OIG) and Federal and State regulations
- Extensive knowledge of medical terminology, anatomy, and pathophysiology, pharmacology, and ancillary test results
- Strong organization and analytical thinking skills – detail oriented
- Proficient with Microsoft Office applications (Outlook, Word, Excel)
- Medical Record audits and review
- Familiarity with the external reporting aspects of healthcare
- Strong knowledge of health records, computerized billing and charging systems, Microsoft applications, data integrity, and processing techniques required.
- Excellent organizational skills, including ability to multi-task, prioritize essential tasks, follow-through and meet timelines.
- Ability to work with accuracy and attention to detail
- Must be able to maintain strict confidentiality of all personal/health sensitive information and ensure compliance of HIPAA rules and regulations.
Benefits:
- medical, dental, vision, pharmacy
- discretionary annual bonuses and merit increases
- Flexible Spending Accounts
- 403(b) savings matches
- paid time off
- career advancement opportunities
- resources to support employee and family well-being
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