Manager, Risk Adjustment Program

Altais Health Solutions; Oakland (CA); Sur place; USD 107 000 - 129 000; Plein temps

Avantages offerts par ce poste

Medical insurance

Vision insurance

Dental coverage

401k with company match

Flexible time off

Résumé du poste

Altais Health Solutions in Oakland, CA, seeks a Manager, Risk Adjustment Program to lead a team of risk adjustment coders and oversee internal audits, ensuring compliance with CMS, AMA, and payer standards. You will drive education, QA programs, and vendor performance while advancing accurate HCC recapture.

A strong coding background, 7+ years of related experience with 3+ years in a lead role, and coding credentialing are required.

Qualifications

• Bachelor’s Degree or equivalent experience in coding and documentation for Risk Adjustment programs.
• 7 years related experience including 3-5 years of professional coding experience.
• 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 (CPC/CRC/CPMA or CCS/CCS-P) is required.

Responsabilités

• Provide oversight and leadership to a team of internal risk adjustment coders and contract staff.
• Hire and manage performance of staff; conduct coder audits regularly per compliance.
• Conduct internal audits of medical record documentation supporting HCC and retrospective coding.
• Pre-audit CMS RADV requests and health plan compliance audits; ensure codes are supported.
• Evaluate diagnoses coded from Risk Adjustment programs for guideline adherence.
• Deliver education and coding training for clinicians and coders to ensure compliance.
• Prepare formal audit reports and present findings to leadership; respond to questions from staff.
• Develop educational programs based on audit findings and expand coding documentation knowledge.
• Perform follow-up reviews to determine additional education needs and monitor improvement.
• Communicate with senior leadership; collaborate on joint projects and vendor oversight related to risk adjustment.

Connaissances

Leadership

Team management

Risk adjustment knowledge

Formation

Bachelor’s degree or equivalent

Coding certificate (CPC/CRC/CPMA or CCS/CCS-P)

Description du poste

About Altais:At Altais, we’re on a mission to improve the healthcare experience for everyone—starting with the people who deliver it. We believe physicians should spend more time with patients and less time on administrative tasks. Through smarter technology, purpose-built tools, and a team-based model of care, we help doctors do what they do best: care for people.Altais includes a network of physician-led organizations across California, including Brown & Toland Physicians, Altais Medical Group Riverside, and Family Care Specialists. Together, we’re building a stronger, more connected healthcare system.About the RoleAre you looking to join a fast-growing, dynamic team?We’re a collaborative, purpose-driven group that’s passionate about transforming healthcare from the inside out. At Altais, we support one another, adapt quickly, and work with integrity as we build a better experience for physicians and their patients.As the Manager, Risk Adjustment Program you will be responsible for leading a team of Risk Adjustment Coders and conducting internal reviews for Providers (documentation) and Coders (coding accuracy) to ensure the organization meets internal and external standards. You will provide regular feedback on performance improvement opportunities to assist senior leadership with implementing benchmarks, establishing acceptable thresholds, and quality assurance programs for risk adjustment. You will be responsible for project oversight and process improvements with management of vendor(s) performance and outcomes.You will focus on:Provide oversight and leadership to a team of internal risk adjustment coders as well as overseeing the work product of contract coding staff.Responsible for hiring and performance management of staff.Perform detailed coder audits on a regular basis as defined by compliance requirements, determine and provide when additional education is necessary.Conduct internal audits of medical record documentation supporting HCC recapture, AWV/AHA coding, and retrospective coding efforts.Conduct pre-audit of CMS RADV requested and/or health plan compliance audits to ensure submitted HCC diagnosis codes are supported in the medical record.Evaluate the appropriateness of diagnoses coded from Risk Adjustment programs, retrospective review, with coding and documentation guidelines.Conduct educational documentation and coding training for clinicians, and coders to support compliance with guidelines from AHA, AMA, CMS and health plan standards.Prepare formalized reports from audit results and present the results to leadership.Respond independently to questions from physicians, practice managers, executive leaders, coders, clinical reviewers, other risk adjustment related staff regarding billing, coding and documentation.Develop educational programs for coders and/or providers based on audit findings along with general education on coding and documentation rules and regulations.Perform follow-up reviews after initial training of the coders and determine if additional education is necessary.Provide any additional training once identified by follow-up review.Communicate regularly with senior leadership to ensure all necessary information is received on a timely basis.Communicate and problem solve with leaders and peers on specific coding issues and/or training requests.Work on joint projects with other teams such as clinical review, coding educators, and others from the specific markets.Conduct oversight and management of vendor(s) performance for risk adjustment activities while monitor and ensure SLAs and SOWs are metPerform any and all other assigned responsibilities.The Skills, Experience & Education You BringBachelor’s Degree or equivalent experience required in coding and documentation for Risk Adjustment programs7 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.The Compensation for this position is $107,100 - $128,500/yearIn addition, we provide a competitive compensation package that recognizes your experience, credentials, and education alongside a robust benefits program to meet your needs.Excellent medical, vision, and dental coverage401k savings plan with a company matchFlexible time off and 9 Paid HolidaysFinal salary determination will take into account the candidate’s geographic location, experience, and qualifications.You Share Our Mission & Values:CompassionWe act with empathy and a deep respect for the challenges faced by physicians and their patients. Our work is driven by a genuine commitment to improving lives and ensuring that care is delivered with dignity, understanding, and humanity.CommunityWe foster a culture of collaboration-with physicians, patients across the healthcare ecosystem, and among our teams. By building strong, trusted relationships, we create a unified community focused on advancing patient care and physician well-being.LeadershipWe lead with integrity and vision, setting the standard for excellence in physician support and healthcare innovation. Through collaboration and expertise, we empower others to lead, drive change, and shape the future of care.ExcellenceWe are relentlessly focused, results-driven, and accountable for delivering measurable value to physicians and the patients they serve. Our high standards reflect our commitment to excellence, operational discipline, and continuous improvement.AgilityWe embrace change as a constant and respond swiftly to the evolving needs of the healthcare industry. With flexibility and forward-thinking, we adapt, innovate, and act decisively to keep physicians at the forefront.Altais values the contribution each Team Member brings to our organization. Final determination of a successful candidate’s starting pay will vary based on several factors, including, but not limited to education and experience within the job or the industry. The pay scale listed for this position is generally for candidates that meet the specified qualifications and requirements listed on this job description. Additional pay may be determined for those candidates that exceed these specified qualifications and requirements. We provide a competitive compensation package that recognizes your experience, credentials, and education alongside a robust benefits program to meet your needs.The anticipated pay range for this role is listed in our salary posting for transparency but may vary based on factors including the candidate’s qualifications, skills, and experience.Altais and its subsidiaries and affiliates are committed to protecting the privacy and security of the personal information you provide to us. Please refer to our ‘CPRA Privacy Notice for California Employees and Applicants’ to learn how we collect and process your personal information when you apply for a role with us.External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.