Risk Adjustment Program Leader (Coding & QA)

Altais Health Solutions; California; Hybrid; USD 107,000 - 129,000; Full time

Benefits offered by this job

Medical coverage

Retirement plan

Paid time off

Job summary

Altais Health Solutions in California seeks a Manager, Risk Adjustment Program to lead a team of risk adjustment coders and oversee vendor coding staff. You will drive audits and education to improve accuracy and compliance across CMS RADV, HCC, and health plan review processes.

The role requires a Bachelor’s degree in coding and documentation, 7 years of related experience including 3–5 years in coding, and proven leadership.

Qualifications

• Bachelor’s Degree or equivalent experience required in coding and documentation for Risk Adjustment programs
• 7 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.

Responsibilities

• Lead a team of risk adjustment coders and oversight of contract coding staff.
• Perform detailed coder audits and provide education as necessary.
• Conduct internal audits of medical record documentation for HCC recapture and retrospective coding.
• Prepare formal audit reports and present results to leadership.
• Ensure coding practices comply with AHA, AMA, CMS and health plan standards.
• Develop educational programs for coders/providers and perform follow-up reviews.

Skills

Leadership

Coding

Risk Adjustment

Compliance

Education

Bachelor's degree or equivalent in coding and documentation for Risk Adjustment

Job description

Altais Health Solutions in California seeks a Manager, Risk Adjustment Program to lead a team of risk adjustment coders and oversee vendor coding staff. You will drive audits and education to improve accuracy and compliance across CMS RADV, HCC, and health plan review processes.

The role requires a Bachelor’s degree in coding and documentation, 7 years of related experience including 3–5 years in coding, and proven leadership.