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 ICD10-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.

Essential Responsibilities / Duties

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

Education Associates Degree Required, Bachelor’s Degree Preferred

Job Requirements

Associates Degree Required, Bachelor’s Degree Preferred

Coding Certification from American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA) is required. Certification may include Certified Risk Adjustment Coder (CRC) or Certified Professional Coder (CPC) and/or Certified Clinical Documentation Specialist- Outpatient or Certified Documentation Expert Outpatient (CDEO) Certified Coding Specialist (CCS), or Certified Coding Specialist Physician-Based (CCS-P), or a Certified Coding Associate (CCA), or Risk Adjustment Coder (RAC), or Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA) required

Experience Minimum of four (4) years progressive coding and/or coding leadership experience in Risk Adjustment Coding

Knowledge and Skills

Willing to work as a team – innovation and collaboration is a priority

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)

Demonstrates critical thinking skills, able to assess, evaluate, and teach

Self-motivated and able to work independently without close supervision

Strong communication skills (interpersonal, verbal and written)

Medical Record audits and review

Familiarity with the external reporting aspects of healthcare

Familiarity with the business aspects of healthcare, including prospective payment systems

Proficient with computer applications (MS Office etc.), Excellent data entry skills

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

Ability to solve problems appropriately using job knowledge and current policies/procedures

Ability to work cooperatively with members of the healthcare delivery team and staff, ability to handle frequent interruptions and adapt to changes in workload and work schedule and to respond quickly to urgent requests

Must be able to maintain strict confidentiality of all personal/health sensitive information and ensure compliance of HIPAA rules and regulations

Compensation Range $72,500.00- $105,000.00

Equal Opportunity Employer/Disabled/Veterans Equal Opportunity Employer/Disabled/Veterans

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