Manager, Risk Adjustment Coding

Mosaic Health, LLC.; Indiana (PA); On-site; USD 85,000 - 128,000; Full time

Job summary

Millennium Physician Group (MPG) is seeking an experienced Risk Adjustment Manager to lead the MRA Team Supervisors and drive CMS data validation and HCC coding initiatives. The role collaborates across departments to optimize chronic condition reviews, provider engagement, education, and documentation compliance.

You will guide workflow improvements and ensure accurate coding to improve patient outcomes and reduce costs.

Qualifications

• Bachelor’s degree or 3 years of equivalent related work experience.
• Current active coding credential through AAPC or AHIMA required.
• Preference given to 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 role.
• Advanced knowledge of medical terminology, anatomy and physiology, major disease processes, and pharmacology.
• Advanced MS Office skills (Excel, Word, Access, PowerPoint).
• Experience with multiple EMR systems and ability to manage workload under deadlines.

Responsibilities

• Subject matter expert for proper risk adjustment coding and CMS data validation.
• Provides daily management of department staff and feedback to Director on performance.
• Oversees hiring, onboarding, and staff development processes.
• Develops provider performance measures through data reviews and analysis.
• Ensures adherence to official guidelines, policies, and standard procedures.
• Leads coding education and training initiatives for staff.
• Identifies risks and develops workflows to support initiatives and audits.

Job description

Job Description Summary

The 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 reviews

How will you make an impact & Requirements

Responsibilities Subject matter expert for proper risk adjustment coding and CMS data validation Provides 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 trends Participates in identifying and developing technology to enhance risk adjustment operations and accuracy Stay 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.

Qualifications Bachelor’s degree or 3 years of equivalent related work experience Current 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 role Advanced 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 Demands

Sedentary 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 Opportunity

MPG 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].

Compensation Range

Compensation Range: $85,159.00 to $127,738.00 The 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.