Supervisor, Risk Adjustment Coding-1

verawholehealth; United States; On-site; USD 90,000 - 120,000; Full time

Job summary

verawholehealth is seeking a Risk Adjustment Supervisor to lead the Coding Specialist team under the Risk Adjustment Manager. You will supervise daily activities, monitor quality and productivity, and guide staff through audits and training.

The role includes prospective, concurrent, and retrospective coding reviews, ensuring CMS data validation and compliance with coding guidelines. Ideal candidates have an active AAPC or AHIMA credential, HCC coding experience, leadership experience, and

Qualifications

• High school diploma or GED equivalent.
• Active coding credential through AAPC or AHIMA required; CRC preferred.
• At least 2 years of coding experience in HCC coding.
• At least 1 year in a lead/senior role.
• Advanced knowledge of medical terminology, anatomy & physiology.
• Extensive knowledge of ICD-10-CM, coding conventions & payment rules.
• Advanced MS Office skills (Excel, Word, Access, PowerPoint).
• Experience with electronic medical records systems.
• Strong time management, accuracy, and dependability.
• Excellent verbal and written communication; able to work with diverse staff.
• Experience in project completion, educational program development & group presentations.
• Commitment to confidentiality and ethical coding standards.

Responsibilities

• Provide daily supervision of department staff and feedback to Risk Adjustment Manager.
• Assist in hiring, onboarding, recognition and discipline of staff.
• Act as preceptor during orientation and train staff.
• Conduct audits to validate accuracy of coding & reviews.
• Provide ongoing feedback on performance and opportunities.
• Ensure adherence to guidelines, policies and procedures.
• Develop staffing schedules to ensure adequate coverage.
• Stay updated on CMS guidelines and coding regulations.
• Lead coding education and training initiatives.
• Lead workgroups and manage project deliverables.
• Analyze MRA data to identify patterns and interventions.
• Provide status reports and identify risks early.

Skills

Communication

Leadership

Time management

Project management

MS Office

EMR systems

Education

High school diploma or GED

Tools

MS Office Suite

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