Manager, Coding and Risk Adjustment

This is a fully remote position, open to applicants in Arizona.

📋 Description

• Lead, mentor, and foster the development of a team comprising Medical Risk Coders and Chart Preparation personnel.

• Conduct performance assessments, coaching sessions, and continuous professional development activities for staff.

• Assist in the recruitment, onboarding, training, and retention of team members in the coding department.

• Set productivity, quality, and performance standards for coding personnel.

• Supervise daily coding operations to ensure accuracy, productivity, and compliance.

• Review medical records and documentation to determine appropriate ICD-10-CM diagnosis codes and identify CMS-HCC opportunities.

• Oversee HCC recapture initiatives, enhancing RAF scores and risk adjustment outcomes.

• Maintain departmental coding accuracy standards of 95% or higher.

• Conduct coding audits and quality assessments, formulating corrective action plans as needed.

• Ensure compliance with CMS, Medicare, Medicaid, HIPAA, and organizational policies.

• Support readiness for internal, external, health plan, and regulatory audits.

• Train and educate providers on coding accuracy, risk adjustment, HCC documentation, HEDIS, and STARS guidelines.

• Review provider documentation and create training resources and coding reference materials.

• Collaborate with clinical leadership to enhance provider documentation and coding performance.

• Provide real-time coding and documentation assistance to providers and clinical teams.

• Develop and track reports on coding accuracy, audit performance, HCC recapture, provider performance, productivity, and quality outcomes.

• Analyze coding trends to implement data-driven operational and financial enhancements.

• Create workflow improvements and support the introduction of new coding processes, technologies, and system upgrades.

• Work in partnership with cross-functional departments to drive scalable infrastructure enhancements.

• Uphold the confidentiality of Protected Health Information (PHI).

• Engage in quality improvement initiatives and undertake additional responsibilities as assigned.

⛳️ Requirements

• Minimum of five (5) years of experience in ICD-10 coding.

• At least three (3) years of experience in Medicare Advantage and Risk Adjustment coding.

• A minimum of two (2) years of experience in a leadership, mentoring, supervisory, or management role.

• Proven experience in conducting coding audits and quality assurance reviews.

• Experience in providing education to providers and supporting documentation improvements.

• In-depth knowledge of ICD-10-CM Coding.

• Strong understanding of CMS-HCC Risk Adjustment Methodology.

• Comprehensive knowledge of Medicare Advantage.

• Familiarity with Medicaid Risk Adjustment.

• Strong knowledge of HEDIS.

• Solid understanding of STARS.

• Proficient knowledge of RAF Scoring.

• Knowledgeable in Provider Documentation Improvement (PDI).

• Familiarity with CMS Documentation Guidelines.

• Understanding of EMR platforms and healthcare technology systems.

• Knowledge of claims, encounters, billing processes, and healthcare reimbursement models.

• Excellent analytical, organizational, and problem-solving capabilities.

• Outstanding written and verbal communication skills.

• Ability to juggle multiple priorities and meet deadlines in a dynamic environment.

• High School Diploma or GED is required.

• Active Certified Risk Adjustment Coder (CRC) credential is required.

• A Bachelor’s degree in healthcare administration, health information management, business administration, nursing, or a related field is preferred.

• Additional coding certifications such as CPC, CCS, RHIT, RHIA are preferred.

• Experience with Salesforce or other CRM platforms is preferred.

• Must be capable of physically performing essential duties, including lifting 30 lbs., transporting materials, stooping, kneeling, crouching, reaching, using hands, balancing, walking, standing, talking, hearing, and typing.

🏝️ Benefits

• Paid Orientation and Training.

• Medical, Dental, Vision, and Life insurance.

• 401k Plan with a 3% match.

• Employee Assistance Program.

• Tuition Reimbursement.

• Continued Education Support.

• Mileage Reimbursement (if applicable).

• Referral Bonuses.

• Paid Holidays (9 days).

• Paid Time Off (20 days).

• Paid Volunteer Hours.

• Fully remote position.