Risk Score Accuracy (RSA) Program Manager - Population Health

Bon Secours Health System; United States; Remote; USD 80,000 - 95,000; Full time

Job summary

A healthcare organization seeks a Program Manager to lead risk score accuracy initiatives. This remote role involves overseeing chart reviews, supporting payer relations, and enhancing coding compliance. Candidates must have extensive experience in quality outcomes and coding, and preferably hold a Bachelor's degree. Competitive compensation and comprehensive benefits are offered.

Benefits

Competitive pay and incentives

Medical, dental, vision coverage

Paid time off and parental leave

Tuition assistance and professional development

Qualifications

• 5 years of experience with risk score accuracy or quality outcomes preferred.
• Certified Professional Coder (CPC) or equivalent is preferred at time of hire.
• Experience working with payer relationships and health systems.

Responsibilities

• Oversee chart reviews for diagnosis coding accuracy to ensure contract success.
• Support payer relationships and coordinate validation processes.
• Deliver HCC coding instruction to ambulatory providers.
• Identify performance improvement opportunities related to coding initiatives.
• Facilitate collaborative coding forums and training sessions.
• Monitor trends for patient populations in value-based contracts.

Skills

Risk Score Accuracy

Program Management

Medical Terminology

CPT

Data Validation

Hierarchical Condition Categories

ICD-10-CM

Payer Relationships

Medical Coding

Data Collection

Analytical Skills

Trend Analysis

Communication

Collaboration

Attention to Detail

Process Improvement

Managing Multiple Priorities

Time Management

Education

Bachelor’s Degree

Tools

Epic Electronic Health Record

Job description

Thank you for considering a career at Bon Secours Mercy Health!

Scheduled Weekly Hours: 40

Work Shift: Days (United States of America)

Primary Function/General Purpose of Position

The Risk Score Accuracy (RSA) Program Manager provides leadership, oversight, coordination, and subject matter expertise for insights related to Population Health Clinical Integration RSA initiatives, including Hierarchical Condition Categories (HCC) coding and other risk adjustment payment models. This role strategizes and collaborates with key stakeholders across the Ministry, including Bon Secours Mercy Health (BSMH) Population Health, Compliance and Revenue Cycle teams, Ensemble, and BSMH physicians and advance care clinicians, to achieve system-wide success in value-based contracts.

This is a remote/work from home position. Hire must be open to working eastern time zone hours.

Essential Job Functions

• Oversees prospective, concurrent, and retrospective chart reviews for diagnosis coding accuracy leading to value-based contract success through compliant coding and documentation.
• Supports payer relationships by coordinating chronic condition recapture and suspect condition validation processes and recording HCC suspect validation responses in payer portals. Collaborates with plan representatives to obtain and analyze RSA gap data. Tracks payer-specific RSA performance to share with providers and leadership. Facilitates responses to payer-focused HCC validation requests and communicates missed HCC trends to System Director of RSA for dissemination to clinical leadership. Monitors payer suspect algorithms for potential internal HCC build improvements.
• Partners with BSMH Compliance to deliver accurate HCC coding instruction as part of ambulatory provider training and onboarding, ensuring compliance with federal and state coding regulations.
• Identifies opportunities for performance improvement related to system-wide HCC and other risk adjustment coding initiatives. Conducts medical record reviews and analyzes internal data to identify opportunities for real-time training intervention related to International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) coding and risk adjustment scores.
• Coordinates and participates in collaborative coding forums with BSMH coders and Revenue Cycle team, BSMH Compliance and Internal Audit teams, Ensemble coding and billing leaders, BSMH leaders, and Population Health team to share best practices and optimize resources.
• Communicates provider coding accuracy concerns and challenges to System and Local Market leadership, delivers or participates in education sessions, and attends coding leadership meetings as requested. Develops HCC and ICD-10-CM coding tools and references.
• Monitors trends for patient populations in value-based contracts and provides feedback to providers and appropriate Ministry leadership to ensure diagnosis coding accuracy and supportive documentation for reduction in compliance risks and costs, as well as appropriate reimbursement based on complexity of patient care.
• Maintains knowledge of professional coding certification requirements and promotes recruitment and retention of certified staff in coding positions within the health system.

Licensing/Certification

Certified Professional Coder (CPC) or equivalent, (preferred at time of hire, required within one year of hire)

Certified Risk Coder (or equivalent), Licensed Practical Nurse or other clinical certification (preferred)

Education

Bachelor’s Degree (preferred)

Work Experience

5 years of experience progressive responsibility, with risk score accuracy or quality outcomes experience, with a payer or in a healthcare system (required)

Training

Epic Electronic Health Record (preferred)

Language

None

Patient Population

Not applicable to this position

Working Conditions

Periods of high stress and fluctuating workloads may occur.

Long-distance or air travel as needed- not to exceed 10% travel.

General office environment.

Required to car travel to off-site locations, occasionally in adverse weather conditions.

Skills

Risk Score Accuracy

Program Management

Medical Terminology

CPT

Data Validation

Hierarchical Condition Categories

ICD-10-CM

Payer Relationships

Medical Coding

Data Collection

Analytical Skills

Trend Analysis

Communication

Communication with all levels

Collaboration

Attention to Detail

Process Improvement

Stakeholders

Managing Multiple Priorities

Time Management

Bon Secours Mercy Health is an equal opportunity employer.

As a Bon Secours Mercy Health associate, you’re part of a Mission that matters. We support your well-being – personally and professionally. Our benefits are built to grow with you and meet your unique needs, every step of the way.

What we offer

• Competitive pay, incentives, referral bonuses and 403(b) with employer contributions (when eligible)
• Medical, dental, vision, prescription coverage, HSA/FSA options, life insurances, mental health resources and discounts
• Paid time off, parental and FMLA leave, shot- and long-term disability, backup care for children and elders
• Tuition assistance, professional development and continuing education support

Bon Secours Mercy Health is an equal opportunity employer. It is our policy to abide by all Federal and State laws, as well as, the requirements of 41 CFR 60-1.4(a), 60-300.5(a) and 60-741.5(a). Accordingly, all applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, sexual orientation, gender identity, age, genetic information, or protected veteran status, and will not be discriminated against on the basis of disability.