Risk Adjustment Coding Leader

verawholehealth; United States; On-site; USD 90,000 - 130,000; Full time

Job summary

verawholehealth seeks a Risk Adjustment Manager to lead the MRA team and oversee risk adjustment coding and quality assurance validation across programs.

The role involves managing staff, developing workflows, ensuring compliance with CMS/Medicare guidelines, and driving data-driven improvements in documentation and coding accuracy.

You will collaborate with multiple departments, mentor staff, and stay current with industry best practices to optimize health outcomes and reduce costs.

Qualifications

• Bachelor's degree or 3 years of equivalent related work experience.
• Active coding credential through AAPC or AHIMA (CRC preferred).
• Minimum 3 years coding experience in HCC coding.
• Minimum 2 years in a lead/senior role.
• Strong knowledge of medical terminology, anatomy, physiology, disease processes, and pharmacology.

Responsibilities

• Subject matter expert for risk adjustment coding and CMS data validation.
• Manages daily department staff and provides feedback to the Director of BOI.
• Oversees hiring, onboarding, and staff discipline processes.
• Develops provider performance measures via data reviews and analysis.
• Ensures adherence to official guidelines and procedures.
• Mentors staff to meet performance requirements and quality standards.
• Provides resources to staff to meet quality and production goals.
• Contributes to reporting on chronic conditions, provider rates, and coder variability.
• Identifies and develops tech to enhance risk adjustment operations.
• Keeps updated on Medicare guidelines and coding regulations.
• Leads coding education and training initiatives for staff.
• Researches best practices and maintains currency in coding literature.
• Evaluates and recommends enhancements to risk adjustment program and guidelines.
• Develops new workflows and policies to support initiatives and audits.
• Leads workgroups and manages project deliverables.
• Reports project status to the Director and flags risks.

Skills

Risk adjustment coding

CMS data validation

Leadership

Communication

Project management

Education

Bachelor's degree

AAPC/AHIMA credential

Tools

MS Office

EMR systems

Job description

verawholehealth seeks a Risk Adjustment Manager to lead the MRA team and oversee risk adjustment coding and quality assurance validation across programs.

The role involves managing staff, developing workflows, ensuring compliance with CMS/Medicare guidelines, and driving data-driven improvements in documentation and coding accuracy.

You will collaborate with multiple departments, mentor staff, and stay current with industry best practices to optimize health outcomes and reduce costs.