Senior Compliance Coordinator (HCC Risk Adjustment) - Professional Coding Division (PCD) - PFS

The University of Iowa; Iowa City (IA); Remote; USD 60,000 - 90,000; Full time

Job summary

An established industry player is seeking a Senior Compliance Coordinator to lead their HCC Risk Adjustment Coding Program. This pivotal role involves ensuring compliance with coding practices and optimizing risk-adjusted payment models to enhance patient outcomes. The ideal candidate will demonstrate strong leadership skills and a comprehensive understanding of risk coding methodologies. In this dynamic position, you will collaborate across departments, drive performance, and foster a culture of continuous improvement. This opportunity offers the chance to make a significant impact in a complex healthcare environment while working remotely or onsite, depending on your preference.

Benefits

Remote Work Flexibility

Professional Development Opportunities

Health and Wellness Programs

Comprehensive Health Insurance

Retirement Savings Plan

Paid Time Off

Employee Assistance Program

Tuition Reimbursement

Qualifications

• 3 years’ experience in risk adjustment medical coding required.
• Strong knowledge of HCC coding guidelines and CMS risk adjustment models.
• Ability to collaborate across departments in a complex environment.

Responsibilities

• Lead and manage the HCC risk adjustment coding program.
• Collaborate with clinical and operational leaders to optimize workflows.
• Develop and implement educational programming for compliance.

Skills

Risk Coding Methodologies

Leadership Skills

Compliance Management

Clinical Knowledge

Problem-Solving Skills

Interpersonal Communication

Education

Bachelor’s Degree in Healthcare Administration

CPC, CRC, CCS-P, CCS-H, RHIT, or RHIA Certification

Master’s Degree (preferred)

Tools

MS Word

PowerPoint

Excel

EPIC

Job description

Senior Compliance Coordinator (HCC Risk Adjustment) - Professional Coding Division (PCD) - PFS

Under the direction of the Associate Director of Professional Coding and the Associate Director of Population Health & ACO Operations, the HCC Risk Adjustment Coding Coordinator is responsible for overseeing all aspects of the UI Health Care Risk Coding Program and supervision of the Risk Coding team. This position plays a pivotal role in ensuring the accuracy and completeness of HCC and HHS risk coding to optimize risk-adjusted payment models and improve patient outcomes.

The role is part of a matrix structure, reporting directly to the Associate Director of Professional Coding, with a dotted line to the Associate Director of Population Health & ACO Operations.

The ideal candidate will possess strong leadership skills, a thorough understanding of risk coding methodologies and risk adjustment, and the ability to drive compliance and performance across multiple departments in a complex healthcare environment.

WE CARE Values:

• Welcoming - We have an environment where everyone has a voice that is heard; that promotes the dignity of our patients, trainees, and employees; and allows all to thrive in their health, work, research, and education.
• Excellence - We achieve and deliver our personal and collective best in the pursuit of quality and accessible health care, education, and research.
• Collaboration - We collaborate with health care systems, providers, and communities across Iowa and the region as well as within our UI community. We believe teamwork—guided by compassion—is the best way to work.
• Accountability -We behave ethically, act with fairness and integrity, take responsibility for our own actions, and respond when errors in behavior or judgment occur.
• Respect - We create an environment where every individual feels safe, valued, and respected, supporting the well-being and success of all members of our community.
• Empowerment - We commit to fair access to research, health care, and education for our community and opportunities for personal and professional growth for our staff and learners.

Position Responsibilities:

• Lead and manage the HCC risk adjustment coding program across the organization, ensuring that coding practices align with CMS guidelines and other regulatory requirements.
• Collaborate with clinical, operational, and financial leaders to optimize HCC coding and documentation workflows.
• Serve as backup for risk coding team when necessary:
• Review documentation available in the Medical Record to facilitate workflows that support the clinical picture/severity of illness/complexity of the patient care rendered to patients.
• Utilize available coding resources to determine the appropriate ICD-10-CM diagnosis codes mapped to HCCs.
• Actively participate in and maintain coding quality and productivity benchmarks.
• Collaborates with department and coding staff to conduct retrospective medical record reviews, ensuring accuracy, assessing severity, and addressing quality concerns.
• Create, monitor, and analyze dashboards and reports to identify trends and areas of improvement, and provide actionable feedback to clinical teams through multi-disciplinary, regular meetings with departmental leadership.
• Provide ongoing feedback to physicians and other providers regarding coding guidelines and requirements.
• Develop and implement educational programming for providers, departments, and clinic staff relating to risk coding and documentation compliance as well as new policies and procedures.
• Partner with the Population Health and ACO Operations teams to align risk adjustment efforts with population health management goals.
• Engage with cross-functional teams and stakeholders, fostering a culture of collaboration and continuous improvement.
• Develop key performance metrics and track progress toward organizational risk adjustment goals.
• Stay up to date with changes in HCC coding regulations, ensuring organizational compliance and implementing necessary updates to processes.
• Supervise risk coding staff. Monitor team performance, and resource needs. Onboard and train new risk coding staff, as needed.

Classification Title:Senior Compliance Coordinator

Specified Area:Audit Compliance Legal & Risk

Department:Patient Financial Services - Professional Coding Division/Population Health

Percent of Time:100% Remote

Pay Grade:4B

Location:Hospital Support Services Building (HSSB) located in Coralville, IA

This position is eligible to participate in remote work and applicants who wish to work remotely will be considered. Training will be held either ONSITE or via ZOOM from the HSSB building at a length determined by the supervisor. Remote eligibility will be evaluated upon a satisfactory job training opportunity. Per policy, work arrangements will be reviewed annually and must comply with the remote work program and related policies and employee travel policy when working at a remote location.

Equipment:

• Onsite: The department will provide a workstation which contains 3 (three) monitors, laptop/power cord, docking station/power cord, keyboard, mouse, headset, and desk supplies can be found in the supply closet.
• Hybrid: While working onsite, the department will provide a workstation which contains 3 (three) monitors, a laptop/power cord, docking station/power cord, keyboard, mouse, headset, and desk supplies. When working offsite, the employee will take their laptop/power cord to carry back and forth, a second docking station/power cord to keep offsite. Prior to working offsite, the employee, at their own expense, will need to supply 2 (two) monitors, a keyboard, a mouse, and provide a screen shot of the domicile internet speed (minimum 30mb download and 10mb upload) and a picture of the office setup.
• Remote: When working offsite, the department will provide the employee a laptop/power cord, docking station/power cord, headset. Prior to working offsite, the employee, at their own expense, will need to supply 2 (two) monitors, a keyboard, a mouse, and provide a screen shot of the domicile internet speed (minimum 30mb download and 10mb upload) and a picture of the office setup.

Education Requirements:

• Bachelor’s degree in healthcare administration, business, finance, or a related field or an equivalent amount of education and experience is required.
• CPC, CRC, CCS-P, CCS-H, RHIT, or RHIA certification is required.

Experience Requirements:

• 3 years’ experience in risk adjustment medical coding
• Strong knowledge of HCC coding guidelines, CMS risk adjustment models, and regulatory requirements.
• Knowledge of insurance regulations and Medicare and Medicaid guidelines as related to clinical documentation and clinical indicators.
• Proven experience in leading coding programs, preferably in a large healthcare organization.
• Strong ability to collaborate across departments and manage stakeholders in a complex, matrixed environment.
• Strong problem-solving and research skills.
• Strong clinical knowledge related to chronic illness diagnosis, treatment and management.
• Ability to interpret CMS regulations and guidance.
• Demonstrated ability to provide coding advice to all areas of coding staff, other departments throughout UI Health Care, and other entities as requested.
• Ability to analyze complex clinical scenarios and apply critical thinking.
• Proven ability to effectively plan, prioritize, and organize tasks to achieve strategic goals.
• Excellent written, verbal, and interpersonal communication skills.
• Proficiency with MS Word, PowerPoint, and Excel, including database and spreadsheet analysis

Desired Qualifications:

• Master’s Degree preferred
• Experience with Medicare Advantage, MSSP, or other value-based care models
• Familiarity with population health initiatives and care coordination in an ACO or similar setting
• Experience performing coding audits
• Knowledge of UI Health Care policies and procedures
• CRC certification
• Experience with EPIC

Application Process:

In order to be considered for an interview, applicants must upload the following documents and mark them as a “Relevant File” for the submission:

• Resume

Job openings are posted for a minimum of 14 calendar days and may be removed from posting and filled any time after the original posting period has ended. Applications will be accepted until 11:59 PM on the date of closing.

Successful candidates will be required to self-disclose any conviction history and will be subject to a criminal background check and credential/education verification. Up to 5 professional references will be requested at a later step in the recruitment process.

Need help submitting an application or accepting an offer? Support is available! Our Applicant Resource Center is now open in the Fountain Lobby at the Main Hospital.

• Classification Title: Senior Compliance Coordinator
• Appointment Type: Professional and Scientific
• Schedule: Full-time

Compensation

Contact Information

Equal opportunity/affirmative action employer

The University of Iowa is an equal opportunity/affirmative action employer. All qualified applicants are encouraged to apply and will receive consideration for employment free from discrimination on the basis of race, creed, color, religion, national origin, age, sex, pregnancy (including childbirth and related conditions), disability, genetic information, status as a U.S. veteran, service in the U.S. military, sexual orientation, gender identity, or associational preferences.

Persons with disabilities who need assistance or accommodations with the application or interview process may contact University Human Resources/Faculty and Staff Disability Services, [phone] or [e-mail] . For jobs in UI Health care, please contact UI Health care Leave & Disability Administration at 319-356-7543 .

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