Senior Risk Coding Manager - Medicare & MassHealth ACO

Community Care Cooperative; Boston (MA); Vor Ort; USD 91.000 - 109.000; Vollzeit

Zusammenfassung

Community Care Cooperative (C3) seeks a Manager, Risk Coding to lead a team of coders in retrospective and prospective risk coding for MassHealth and Medicare ACO contracts. You will drive documentation quality, risk adjustment accuracy, and compliance across multiple EHR systems.

The role requires leadership experience, deep knowledge of CMS-HCC Version 28 and MassHealth DxCG models, and strong QA/reporting capabilities to deliver timely coding performance updates to health centers.

Qualifikationen

• 5+ years risk coding experience
• 3+ years of Medicare ACO risk adjustment experience incl CMS-HCC Version 28
• Knowledge of Medicaid risk adjustment models (MassHealth DxCG)
• 5+ years medical billing in outpatient settings
• 2-4 years leadership of coding teams (productivity/quality)
• Billing compliance expertise
• Experience with data analysis and reporting on risk scores/productivity/accuracy
• Arcadia familiarity
• Medical terminology, anatomy, physiology, and disease knowledge
• Knowledge of Epic/NextGen/Centricity/eCW
• Self-starter with initiative and judgement
• MS Office proficiency
• Attention to detail on deliverables

Aufgaben

• Serve as expert on ICD-10-CM coding guidelines and Risk Adjustment methodologies
• Maintain QA of coding projects via internal audits of charts
• Review records with familiarity of Epic/NextGen/Centricity/eCW
• Develop and deliver provider reports and feedback for billable modifications
• Use population health tools to create pre-visit coding workflows
• Develop and maintain coding educational tools
• Assess team performance and provide feedback to employees
• Hire/train staff and develop SOPs for coding team
• Oversee daily operations and coding team performance
• Manage monthly production targets and health center reporting commitments
• Support MSSP and MassHealth DxCG risk adjustment strategies
• Establish and report coder productivity/quality metrics and coach staff
• Translate audits into provider education and workflow improvements
• Ensure CMS/OIG/MassHealth compliance and escalate as needed
• Prepare monthly coding performance updates for leadership
• Perform other duties as assigned

Kenntnisse

Risk coding

Medicare ACO

DxCG Medicaid

Medical billing

Leadership

Billing compliance

Data analytics

Arcadia

Medical knowledge

EHR systems

Self-starter

MS Office

Attention to detail

Ausbildung

Bachelors in healthcare admin

CPC/CCS certifications

CRC (preferred)

Tools

Epic

NextGen

Centricity

eCW

Jobbeschreibung

Community Care Cooperative (C3) seeks a Manager, Risk Coding to lead a team of coders in retrospective and prospective risk coding for MassHealth and Medicare ACO contracts. You will drive documentation quality, risk adjustment accuracy, and compliance across multiple EHR systems.

The role requires leadership experience, deep knowledge of CMS-HCC Version 28 and MassHealth DxCG models, and strong QA/reporting capabilities to deliver timely coding performance updates to health centers.