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About the role
Key responsibilities & impact- Lead a team of internal risk adjustment coders and oversee contract coding staff
- Hire and manage staff performance
- Perform detailed coder audits and determine when additional education is necessary
- Conduct internal audits of medical record documentation supporting HCC recapture, AWV/AHA coding, and retrospective coding efforts
- Conduct pre-audits of CMS RADV and/or health plan compliance audits
- Evaluate diagnoses coded from Risk Adjustment programs against coding and documentation guidelines
- Conduct educational documentation and coding training for clinicians and coders
- Prepare formalized audit reports and present results to leadership
- Respond to questions from physicians, practice managers, executive leaders, coders, clinical reviewers, and risk adjustment staff
- Develop educational programs based on audit findings and coding/documentation rules
- Perform follow-up reviews and provide additional training
- Communicate with senior leadership regarding required information
- Collaborate with leaders and peers on coding issues and training requests
- Work on joint projects with clinical review, coding educators, and specific-market teams
- Oversee vendor performance and ensure SLAs and SOWs are met
- Perform other assigned responsibilities
Requirements
What you’ll need- Bachelor’s Degree or equivalent experience required in coding and documentation for Risk Adjustment programs
- 7 years related experience including 3-5 years of professional coding experience required
- 3 years’ experience in a lead role
- Experience implementing risk adjustment coding compliance rules and regulations
- Successful completion of Coding Certificate program from an accredited organization (i.e. CPC, CRC, CPMA from AAPC, or CCS, CCS-P from AHIMA) is required
- External hires must pass a background check/drug screen
- Qualified applicants with arrest records and/or conviction records will be considered in accordance with applicable laws
Benefits
Comp & perks- Excellent medical, vision, and dental coverage
- 401k savings plan with a company match
- Flexible time off
- 9 Paid Holidays
- Competitive compensation package
- Robust benefits program