Manager, Risk Adjustment Coding

To be successful in this role, you:

• Are committed to advancing diversity, equity, and inclusion across CHPW.
• Have a minimum of 2 years of experience leading teams as a supervisor or manager.
• Have a minimum of 5 years of experience in medical coding, preferably in a health plan setting.
• Are a Certified Risk Adjusted Coder (CRC).
• Are a certified American Health Information Management (AHIMA) Certified Coding Specialist (CCS), or American Academy of Professional Coder (AAPC) Certified Professional Coder (CPC) or Certified Professional Coder – Hospital (CPC-H) Coding Certificate.
• Have proficiency in Microsoft Office applications such as Outlook, Word, Excel.

Essential functions and Roles and Responsibilities:

• Oversee the daily operations of the Risk Adjustment Coding program, including managing a team of coders and providing guidance on coding best practices and compliance with relevant regulations.
• Responsible for planning, managing, and communicating coding work project plans, and setting clear goals and objectives for the program.
• Ensure all claims are coded accurately, completely, and in compliance with all regulatory requirements and health plan policies.
• Develop and implement policies and procedures to ensure compliance with CMS and other regulatory requirements related to Risk Adjustment Coding.
• Monitor coding accuracy and productivity metrics and implement performance improvement initiatives as needed.
• Conduct regular audits of coding processes and procedures to identify opportunities for improvement and ensure compliance with coding guidelines and regulations.
• Review and analyze medical records, encounter forms, and other documentation to accurately assign and validate ICD-10-CM, CPT, HCPCS, and other relevant codes for Risk Adjustment purposes.
• Provide training and education to internal stakeholders on coding and Risk Adjustment Act as a liaison between internal departments and external entities on regulatory data validation audits (including CMS RADV and HHS RADV) processes.
• Support development of education and training on coding guidelines and regulations to medical providers and health plan staff.
• Work collaboratively with other departments within the health plan, such as Quality, HEDIS, and Case Management, to ensure accurate and timely submission of data to government programs.
• Collaborate with health plan staff, Risk Adjustment team members, and other stakeholders to resolve coding-related issues and concerns.
• Exempt – Employees are expected to report to work as scheduled, participate in all assigned meetings, and meet established performance and accountability standards.
• Other duties as assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion.

Knowledge, Skills, and Abilities:

• Ability to set performance expectations, coach for performance success, and achieve department and company objectives.
• Knowledge of Risk Adjustment Coding guidelines, regulations, and industry trends and best practices and technology advancements.
• Knowledge of CMS Hierarchical Condition Categories (HCCs) and HHS-HCC models.
• Knowledge of Medicaid Chronic Illness and Disability Payment System (CDPS) model.
• Ability to work with Natural Language Processing (NLP), and computer assisted coding applications.

As part of our hiring process, the following criteria must be met:

• Complete and successfully pass a criminal background check.

Criminal History: includes review of criminal convictions and probation. CHPW does not automatically or categorically exclude persons with a criminal background from employment. The applicant’s criminal history will be reviewed on a case-by-case basis considering the risk to the business, members, and/employees.

• Has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency.
• Vaccination requirement (CHPW offers a process for medical or religious exemptions)
• Candidates whose disabilities make them unable to meet these requirements are considered fully qualified if they can perform the essential functions of the job with reasonable accommodation.

Compensation and Benefits:

The position is FLSA Exempt and is not eligible for overtime. Based on market data, this position grade is 67 and has a 10% annual incentive target based on company, department, and individual performance goals.

CHPW offers the following benefits for Full and Part-time employees and their dependents:

•  Medical, Prescription, Dental, and Vision
•  Telehealth app
•  Flexible Spending Accounts, Health Savings Accounts
•  Basic Life AD&D, Short and Long-Term Disability
•  Voluntary Life, Critical Care, and Long-Term Care Insurance
•  401(k) Retirement and generous employer match
•  Employee Assistance Program and Mental Fitness app
•  Financial Coaching, Identity Theft Protection
•  Time off including PTO accrual starting at 17 days per year.
•  40 hours Community Service volunteer time
•  10 standard holidays, 2 floating holidays
•  Compassion time off, jury duty

Sensory/Physical/Mental Requirements:

Sensory*:

• Speaking, hearing, near vision, far vision, depth perception, peripheral vision, touch, smell, and balance.

Physical*:

• Extended periods of sitting, computer use, talking and possibly standing

• Simple grasp, firm grasp, fine manipulation, pinch, finger dexterity, supination/pronation, wrist flexion

• Frequent torso/back static position; occasional stooping, bending, and twisting. 

Mental:

• Frequent decision-making. Ability to gather and assess data, determine appropriate actions, apply protocols and knowledge to unique situations, problem-solve and provide consultation.
• Must be able to manage conflict, communicate effectively and meet time-sensitive deadlines.