Risk Adjust Prgm Team Lead / Clinical Integration

Hartford HealthCare; Hartford (CT); On-site; USD 90,000 - 120,000; Full time

Benefits offered by this job

Competitive benefits

Job summary

Hartford HealthCare in Hartford, CT is seeking an experienced Risk Adjustment Program Team Lead to coordinate the Risk Adjustment team, verify coding reviews, and ensure reports are accurate. The role partners with the Director of Quality and Clinical Integration to improve workflows and drive network initiatives, aligning coding with CMS guidelines.

Requires 5+ years in Risk Adjustment/HCC, knowledge of Medicare Advantage, and leadership experience.

Qualifications

• Minimum: Associate's degree in a health-related field or equivalent work experience
• Preferred: Bachelor's Degree in a health-related field or equivalent work experience

Responsibilities

• Oversee complex ICD-10 and HCC coding and documentation training programs
• Implement training programs for network providers across settings
• Collaborate with clinical, operational, and financial leaders to optimize HCC workflows
• Review medical records to support documentation and clinical severity
• Develop training guides and standard work documents
• Maintain coding quality and productivity benchmarks
• Collaborate on retrospective and targeted medical record reviews
• Develop educational programming for providers and departments
• Stay up to date with HCC coding regulations and ensure compliance

Skills

Leadership

Communication

Project management

HCC knowledge

CMS regulations

Education

Associate's degree

Bachelor's degree (preferred)

Tools

MS Word

Excel

PowerPoint

Job description

Location Detail: 100 Pearl Street Hartford (10484)

Work where every moment matters.

Every day, over 40,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut's most comprehensive healthcare network.

The creation of the HHC System Support Office recognizes the work of a large and growing group of employees whose responsibilities are continually evolving so that we and our departments now work on behalf of the system as a whole, rather than a single member organization.

With the creation of our new umbrella organization we now have our own identity with a unique payroll, benefits, performance management system, service recognition programs and other common practices across the system.

Position Summary

Reporting to the Director of Quality and Clinical Integration, the Risk Adjustment Program Team Lead serves as a coordinator and resource for the Risk Adjustment team; works with other coders to ensure that all coding reviews are completed in a timely manner; verifies accuracy of reports; completes own workload of coding reviews, and identifies training needs based on questions/guidance requests from the coding team. The Team Lead works closely with the Director to identify opportunities to update Risk Adjustment workflows or initiate new workflows to drive network initiatives and achieve the organization's overall goals.

Position Responsibilities

Key Areas of Responsibility

• Oversee the development of complex and advanced ICD-10 and Hierarchical Condition Category (HCC) coding and documentation training programs, including defining training objectives, developing training materials, and tools.
• Implement documentation and coding training programs for network providers, presenting coding and documentation education in an appropriate format across a variety of settings.
• Collaborate with clinical, operational, and financial leaders to optimize HCC coding and documentation workflows that support the HCC risk adjustment coding program across the organization, ensuring that coding practices align with CMS guidelines and other regulatory requirements.
• Review documentation available in the medical record to facilitate workflows that support the clinical picture/severity of illness/complexity of the patient care rendered to patients.
• Create "train the trainer guides" and standard work documents.
• Actively participate in and maintain coding quality and productivity benchmarks.
• Collaborate with colleagues and departments across the organization to perform retrospective and other targeted medical record reviews, ensuring documentation accuracy, evaluating clinical severity, identifying quality concerns, and supporting continuous improvement across evolving review priorities.
• Develop and implement educational programming for providers, departments, and clinic staff relating to risk coding and documentation compliance, as well as new policies and procedures.
• Stay up to date with changes in HCC coding regulations, ensuring organizational compliance, and implementing necessary updates to processes.

Working Relationships

Perform other related duties as required

This Job Reports To (Job Title)

Director of Quality and Clinical Integration, ICP

Qualifications

Requirements and Specifications:

Education

• Minimum: Associate's degree in a health-related field or equivalent work experience
• Preferred: Bachelor's Degree in a health-related field or equivalent work experience

Experience

• Minimum:
• 5+ years of dedicated Risk Adjustment / HCC coding experience
• Strong knowledge of Medicare Advantage and CMS Risk Adjustment models
• Experience with:
• Pre-visit reviews
• Concurrent reviews
• Retrospective audits
• Documentation validation
• Suspect condition workflows
• Preferred:
• Strong understanding of HCC capture, recapture, RAF impact, and coding compliance principles.
• Experience working directly with providers on documentation clarification and coding education.
• Strong audit and documentation review sophistication.
• Progressively responsible role with leadership experience and previous experience working in an educational/training role preferred.

Licensure, Certification, Registration

• Minimum:
• Must possess at least one of the following certifications:
• Medical Coding Certification
• Certified Professional Coder (CPC)
• Certified Coding Specialist - Physician (CCS-P)
• Certified Coding Specialist (CCS)
• Preferred: Certified Risk Adjustment Coder (CRC) preferred

Knowledge, Skills, And Ability Requirements

• This is an on-site position.
• Requires travel to multiple practice locations.
• Reliable transportation, insurance, and a valid driver's license
• Must be able to excel in a fast-paced business environment, handling multiple priorities.
• Must be highly effective in both written and oral communication.
• Must be able to exercise appropriate judgment when making decisions.
• Commitment to maintain complete confidentiality of patient health information (PHI).
• Ability to innovate to achieve the organization’s goals.
• Strong business, analytical, and project management skills; a good understanding of revenue cycle management, health care finance, and processes (including clinical workflows).
• Ability to understand and convey complex information to many different audiences is an absolute requirement, with demonstrated ability to work as a member of a team.
• Must rely on extensive experience and judgment to plan and accomplish goals.
• Must be organized and detail-oriented with a proven record of follow-up and problem resolution.
• Proven leadership skills in physician practice relationships that include influencing, efficiency, collaboration, candor, and openness with a focus on results.
• Proficient with MS Word, Excel, PowerPoint, and computer user interfaces.
• Engage with cross-functional teams and stakeholders, fostering a culture of collaboration and continuous improvement.

We take great care of careers.

With locations around the state, Hartford HealthCare offers exciting opportunities for career development and growth. Here, you are part of an organization on the cutting edge - helping to bring new technologies, breakthrough treatments and community education to countless men, women and children. We know that a thriving organization starts with thriving employees-- we provide a competitive benefits program designed to ensure work/life balance. Every moment matters. And this is your moment.