Manager, Risk Adjustment Coding

Millennium Physician Group; Bloomington (IN); On-site; USD 85,000 - 128,000; Full time

Job summary

Millennium Physician Group in Bloomington, IN is seeking a Risk Adjustment (RA) Manager to oversee the MRA Team Supervisors and drive compliant risk-adjustment coding practices across the organization.

You will develop workflows for chart reviews, mentor staff, coordinate with providers, stay current with CMS guidelines, and lead education initiatives to improve documentation, prevalence rates, and medical margins while reducing costs.

Qualifications

• Bachelor’s degree or 3 years related work experience.
• Current active coding credential through AAPC or AHIMA required.
• CRC designation preferred.
• Minimum three years coding experience in HCC coding.
• Two years lead/senior role experience.
• Advanced knowledge of medical terminology, anatomy, pharmacology.
• Proficiency with MS Office and EMR systems.
• Strong organizational and communication skills.

Responsibilities

• Oversee RA team and provide performance feedback to leadership.
• Develop workflows for chart reviews and coding accuracy.
• Lead education initiatives for staff and providers.
• Coordinate with providers to improve documentation and prevalence rates.
• Stay updated on CMS guidelines and reimbursement changes.
• Provide regular status reports and manage project deliverables.

Skills

Risk adjustment coding

CMS data validation

Staff management

Education & training

HCC coding

Communication

Attention to detail

Education

Bachelor’s degree or 3 years related work experience

Current coding credential through AAPC or AHIMA

Tools

MS Office

EMR systems

Coding software

Job description

Job Description SummaryThe Risk Adjustment (RA) Manager reports to the Director of Burden of Illness (BOI). S/he performs duties to conduct the day-to-day management of the MRA Team Supervisors and team functions by communicating with other operational departments and provider offices. S/he will participate in the development, implementation, and performance of workflows for reviewing electronic medical records aimed at improving the health and well-being of patients through appropriate identification of chronic disease conditions. This role will collaborate with all areas of the organization to ensure success of our value-based coding initiatives such as provider engagement, education, prevalence rates, documentation compliance and medical margin. He/she will support and further enhance the data and reporting model to capture and optimize ICD-10 reporting to payers to improve quality for our patients and reduce healthcare costs.This position manages risk adjustment coding and quality assurance validation for the following programs, including but not limited to:• Prospective medical record review• Concurrent outpatient claim diagnosis coding• Retrospective medical record and provider response reviewsHow will you make an impact & RequirementsResponsibilitiesSubject matter expert for proper risk adjustment coding and CMS data validationProvides daily management of department staff and provides feedback to the Director of BOI on exceptional and/or substandard performance.Oversees and ensures completion of all efforts associated with hiring, interviewing, onboarding, and recognition and discipline of staff.Execute on the continued development of provider performance measures on important aspects of care and service through data reviews and data-driven analysis.Provides ongoing feedback to staff on areas of success and improvement opportunities.Ensures that all members of the team are following official guidelines, policies, and standard procedures.Counsels staff on actions required to meet minimum performance requirements.Provides or arranges for necessary knowledge-based resources required by the department staff to meet quality and production standards.Contributes to the reporting for reassessment of chronic conditions, provider address rates, coder variability, and other risk adjustment coding related measure trendsParticipates in identifying and developing technology to enhance risk adjustment operations and accuracyStay updated on changes to Medicare guidelines, coding regulations, and reimbursement methodologies to ensure compliance and accuracy in coding practices.Develop and lead coding education and training initiatives for staff to promote consistent and accurate coding practices across the organization.Research best practices in risk adjustment coding and reviews the professional literature for coding updates, maintaining currency in coding.Evaluates, researches, and recommends enhancements to the risk adjustment program and internal coding guidelines.Develops and implements new workflows and policies and procedures as needed to support new and existing department initiatives, audits, and projects.Lead workgroups and manage project deliverables for department initiatives, audits, and provider communications.Keeps department Director apprised of project activities through regular written and oral status reports. Proactively identifies risks that may hinder project success.QualificationsBachelor’s degree or 3 years of equivalent related work experienceCurrent active coding credential through AAPC or AHIMA required. **Preference given to those with CRC designation.Minimum of three (3) years coding experience directly related to Hierarchical Condition Category (HCC) coding.Minimum of two (2) year experience in a lead/senior roleAdvanced knowledge of medical terminology, abbreviations, anatomy and physiology, major disease processes, and pharmacology.Extensive knowledge of coding conventions and payment rules as they apply to medical record documentation, billing of medical services, and health care reimbursement systems. This includes a comprehensive understanding of ICD-10-CM.Advanced skills for use of MS Office (Excel, Word, Access, and PowerPoint).Demonstrated ability to utilize a variety of electronic medical records systems.Ability to manage significant workload, and to work efficiently under pressure meeting established deadlines with minimal supervision. Strong time management skills. Must possess high degree of accuracy, efficiency, and dependability.Demonstrated ability to communicate clearly and effectively with a wide variety of individuals at all levels of the organization both verbally and written.Demonstrated organizational and problem-solving ability.Demonstrated experience in project completion, educational program development and/or group presentation.Commitment to maintaining confidentiality and adhering to ethical coding standards.Physical DemandsSedentary work. Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Repetitive motion. Substantial movements (motions) of the wrists, hands, and/or fingers. The worker must have close visual acuity to perform an activity such as: preparing and analyzing data and figures; transcribing; viewing a computer terminal; extensive reading. Ability to lift to 15 lbs. independently not to exceed 50 lbs. without help.Equal Employment OpportunityMPG is committed to equal employment opportunities. We will not discriminate against employees or applicants for employment in employment opportunities or practices based on race, color, sex (including pregnancy), genetic information, sexual orientation, religion, physical or mental disability, age, military or veteran status, marital status, familial status, national origin, or any other legally protected class.Equal opportunity applies to all areas of the employment relationship, including hiring, promotions, training, terminations, working conditions, pay, and other terms and conditions of employment.Millennium Physician Group (MPG) is committed to the full inclusion of all qualified individuals. In keeping with our commitment, MPG will take steps to assure that people with disabilities are provided reasonable accommodations. Accordingly, if reasonable accommodation is required to fully participate in the job application or interview process, to perform the essential functions of the position, and/or to receive all other benefits and privileges of employment, contact [e-mail] Range:$85,159.00to$127,738.00The anticipated base salary range represents the Company's good-faith estimate of the compensation it reasonably expects to pay for this position at the time of posting. Actual compensation will be determined based on factors including experience, skills, qualifications, geographic location, internal equity, and business needs.