Risk Adjustment & HCC Program Lead — Hybrid

Bluestone Physician Services; Florida; Hybride; USD 120 000 - 138 000; Plein temps

Avantages offerts par ce poste

Health Insurance

Dental Insurance

Vision Materials Insurance

Company paid Life Insurance

Company paid Short and Long-term Disb.

Health Savings Account (HSA)

Flexible Spending Account (FSA)

Retirement plan with 4% matching

Paid Holidays

PTO

Company sponsored cell phone

Résumé du poste

Bluestone Physician Services is seeking a Risk Adjustment & HCC Program Manager to optimize coding operations and ensure compliant, patient‑centered care. Lead a two-person team, bridge clinical, EHR, and RCM functions, and standardize workflows.

The role reports to the SVP of Clinical Operations and requires a flexible hybrid work arrangement across Minnesota, Wisconsin, or Florida. Salary ranges reflect market norms for senior risk adjustment roles.

Qualifications

• 5+ years in healthcare with risk adjustment coding and HCC program management.
• CRC certification or willingness to obtain within timeframe after hire.
• CPC or CCS credentials preferred.
• Deep knowledge of CMS-HCC risk adjustment models and ICD-10-CM coding guidelines.

Responsabilités

• Directly oversee and develop a small risk adjustment coding team; manage workload and performance.
• Design and manage standardized risk adjustment queries and provider approvals.
• Coordinate with provider network, EHR, and RCM teams to ensure alignment.
• Ensure CMS, OIG, and internal policies compliance through audits and quality reviews.
• Develop educational materials to improve clinical documentation integrity at the point of care.
• Collaborate with analytics to define KPIs and monitor HCC capture and query rates.
• Continuously evaluate and improve risk adjustment programs for efficiency and accuracy.

Connaissances

Team leadership

Risk adjustment

HCC coding

CMS guidelines

Analytical mindset

Formation

CRC certification (AAPC)

CPC or CCS preferred

Outils

EHR systems

Description du poste

Bluestone Physician Services is seeking a Risk Adjustment & HCC Program Manager to optimize coding operations and ensure compliant, patient‑centered care. Lead a two-person team, bridge clinical, EHR, and RCM functions, and standardize workflows.

The role reports to the SVP of Clinical Operations and requires a flexible hybrid work arrangement across Minnesota, Wisconsin, or Florida. Salary ranges reflect market norms for senior risk adjustment roles.