Risk Adjustment Coding Manager - MRA & Compliance

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

Job summary

Millennium Physician Group is seeking a Risk Adjustment Manager to oversee the MRA Team and drive accurate ICD-10 reporting for value-based care initiatives. You will partner with BOI and other departments to optimize workflows, audits, and education across the organization.

This role demands leadership, coding expertise, and strong data-driven decision making. The role requires CMS guidance knowledge, clinical terminology mastery, and experience managing staff while ensuring compliance with

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, 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.
• 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.

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.

Skills

HCC coding

Medical terminology

CMS data validation

Communication

Leadership

Project management

Time management

ICD-10-CM knowledge

MS Office

EMR systems

Education

Bachelor’s degree or 3 years related work experience

AAPC/AHIMA credential (CRC preferred)

Tools

EMR systems

MS Office Suite

Job description

Millennium Physician Group is seeking a Risk Adjustment Manager to oversee the MRA Team and drive accurate ICD-10 reporting for value-based care initiatives. You will partner with BOI and other departments to optimize workflows, audits, and education across the organization.

This role demands leadership, coding expertise, and strong data-driven decision making. The role requires CMS guidance knowledge, clinical terminology mastery, and experience managing staff while ensuring compliance with