Supervisor, Risk Adjustment Coding-1

Mosaic Health, LLC.; Indiana (PA); On-site; USD 64,000 - 96,000; Full time

Job summary

Mosaic Health is seeking a Risk Adjustment Supervisor to oversee the Risk Adjustment Coding Specialist team, ensuring accuracy, productivity, and adherence to guidelines. You will supervise daily activities, participate in hiring and onboarding, and serve as a resource for staff on coding and validation across HCC initiatives.

You will lead audits, educate staff on CMS data validation, and develop workflows to improve performance and compliance while coordinating with management on staffing and

Qualifications

• High school diploma or GED.
• Current active coding credential through AAPC or AHIMA.
• CRC designation preferred.
• Minimum of two years coding experience related to HCC coding.
• Minimum of one year experience in a lead/senior role.
• Advanced knowledge of medical terminology, anatomy and physiology, major disease processes, and pharmacology.
• Extensive knowledge of coding conventions and ICD-10-CM.
• Advanced MS Office skills (Excel, Word, Access, PowerPoint).
• Experience with multiple electronic medical records systems.

Responsibilities

• Provide daily supervision of department staff and feedback to the Risk Adjustment Manager.
• Assist with hiring, interviewing, onboarding, and discipline of staff.
• Serve as a preceptor to new employees during orientation.
• Lead ongoing training initiatives for staff.
• Conduct audits of coding work to validate accuracy and identify discrepancies.
• Ensure staff follow official guidelines, policies, and procedures.
• Prepare staffing schedules to provide adequate coverage.
• Develop and implement new workflows and policies as needed.
• Identify risks and propose interventions at provider and regional levels.

Skills

Leadership

Communication

Project management

Time management

Attention to accuracy

Education

High school diploma or GED

AAPC/AHIMA credential

CRC designation preferred

Tools

MS Office

EMR systems

Job description

Job Description Summary

Under the direction of the Risk Adjustment Manager, the Risk Adjustment Supervisor is responsible for providing first-line supervision for the Risk Adjustment Coding Specialist. Supervisor responsibilities include but are not limited to daily supervision and monitoring of quality and productivity performance, interviewing, hiring, and any necessary discipline of staff. This position supervises risk adjustment coding and quality assurance validation for the following programs, including but not limited to:

• Prospective medical record review
• Concurrent outpatient claim diagnosis coding
• Retrospective medical record and provider response reviews

How will you make an impact & Requirements

Responsibilities

Subject matter expert for proper risk adjustment coding and CMS data validation Provides daily supervision of department staff and provides feedback to the Risk Adjustment Manager on exceptional and/or substandard performance. Support Manager in efforts associated with hiring, interviewing, onboarding, and recognition and discipline of staff. Serves as a preceptor to new employees during the orientation process. Functions as a resource to existing staff for projects and daily work. Facilitates ongoing training for optimal staff functioning. Conduct audits of Risk Adjustment Coding Specialist work to validate the accuracy and completeness of diagnosis suspects, claim submission, and/or retrospective reviews identifying and resolving any discrepancies or areas for improvement. Provides ongoing feedback to staff on areas of success and improvement opportunities. Ensures that all members of the team are following official guidelines, policies, and standard procedures. Counsels staff on actions required to meet minimum performance requirements. Provides or arranges for necessary knowledge-based resources required by the department staff to meet quality and production standards. Prepares staffing schedules to provide adequate coverage for all bodies of work. Stay updated on changes to Medicare guidelines, coding regulations, and reimbursement methodologies to ensure compliance and accuracy in coding practices. Develop and lead coding education and training initiatives for staff to promote consistent and accurate coding practices across the organization. Research best practices in risk adjustment coding and reviews the professional literature for coding updates, maintaining currency in coding. Evaluates, researches, and recommends enhancements to the risk adjustment program and internal coding guidelines. Develops and helps implement new workflows and policies and procedures as needed to support new and existing department initiatives, audits, and projects. Lead workgroups and manage project deliverables for department initiatives, audits, and provider communications. Analyze MRA data to identify patterns and when requested assist in the development of interventions at the provider and region level. Keeps department Manager apprised of project activities through regular written and oral status reports. Proactively identifies risks that may hinder project success.

Qualifications

• High school diploma or GED equivalent
• Current active coding credential through AAPC or AHIMA required.
• Preference given to those with CRC designation.
• Minimum of two (2) years coding experience directly related to Hierarchical Condition Category (HCC) coding.
• Minimum of one (1) year experience in a lead/senior role
• Advanced knowledge of medical terminology, abbreviations, anatomy and physiology, major disease processes, and pharmacology.
• Extensive knowledge of coding conventions and payment rules as they apply to medical record documentation, billing of medical services, and health care reimbursement systems. This includes a comprehensive understanding of ICD-10-CM.
• Advanced skills for use of MS Office (Excel, Word, Access, and PowerPoint).
• Demonstrated ability to utilize a variety of electronic medical records systems.
• Ability to manage significant workload, and to work efficiently under pressure meeting established deadlines with minimal supervision.
• Strong time management skills.
• Must possess high degree of accuracy, efficiency, and dependability.
• Demonstrated ability to communicate clearly and effectively with a wide variety of individuals at all levels of the organization both verbally and written.
• Demonstrated organizational and problem-solving ability.
• Demonstrated experience in project completion, educational program development and/or group presentation.
• Commitment to maintaining confidentiality and adhering to ethical coding standards.

Physical Demands

Sedentary work. Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Repetitive motion. Substantial movements (motions) of the wrists, hands, and/or fingers. The worker must have close visual acuity to perform an activity such as: preparing and analyzing data and figures; transcribing; viewing a computer terminal; extensive reading. Ability to lift to 15 lbs. independently not to exceed 50 lbs. without help.

Equal Employment Opportunity

MPG is committed to equal employment opportunities. We will not discriminate against employees or applicants for employment in employment opportunities or practices based on race, color, sex (including pregnancy), genetic information, sexual orientation, religion, physical or mental disability, age, military or veteran status, marital status, familial status, national origin, or any other legally protected class. Equal opportunity applies to all areas of the employment relationship, including hiring, promotions, training, terminations, working conditions, pay, and other terms and conditions of employment. Millennium Physician Group (MPG) is committed to the full inclusion of all qualified individuals. In keeping with our commitment, MPG will take steps to assure that people with disabilities are provided reasonable accommodations. Accordingly, if reasonable accommodation is required to fully participate in the job application or interview process, to perform the essential functions of the position, and/or to receive all other benefits and privileges of employment, contact [e-mail].

Compensation Range

Compensation Range: $63,982.00 to $95,972.00 The anticipated base salary range represents the Company's good-faith estimate of the compensation it reasonably expects to pay for this position at the time of posting. Actual compensation will be determined based on factors including experience, skills, qualifications, geographic location, internal equity, and business needs.

Security

Beware of fraudulent job postings: While Mosaic Health job advertisements may be found on many sites, our current openings page and its associated Workday account are the only places we accept applications for open roles. If you suspect a job post is fraudulent, please let us know at [e-mail]. Mosaic Health is a national care delivery platform focused on expanding access to comprehensive primary care for consumers with coverage across Commercial, Individual Exchange, Medicare, and Medicaid health plans.

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