Professional Services - Sr. Manager, Risk Adjustment

About Us
Tabula Rasa HealthCare (TRHC) is a leader in providing patient-specific, data-driven technology and solutions that enable healthcare organizations to optimize performance to improve patient outcomes, reduce hospitalizations, lower healthcare costs, and manage risk. Medication risk management is TRHC’s lead offering, and its cloud-based software applications provide solutions for a range of payers, providers, and other healthcare organizations. We’re on a mission to enable simplified and individualized care that improves the health of those we serve.
We’re looking for people who are excited to drive this transformation. To break barriers and think of new ways to adapt, help, and create better experiences for patients—and for each other. This is where diverse backgrounds, beliefs, and perspectives matter and where “care” is centric to who we are. Come do more than join something, change something. For patients, for their families, for the future of healthcare.
DATE: 04/2023 REVISED: N/A
JOB TITLE: Senior Manager
REPORTS TO: Senior VP
DEPARTMENT(S):Risk Adjustment Services
FLSA: Exempt
JOB OBJECTIVE: The Senior Manager leads, develops, and manages coding, auditing and quality assessment managerial staff and teams to optimize compliance and revenue through accurate and complete documentation, submission of diagnosis codes, and ongoing analysis of Hierarchical Condition Category (HCC) and RxHCC risk scores.
This position has a key role in developing and/or managing initiatives that enable staffto serve as liaison to clients, coordinate services to fulfill client needs and ensure client obligations are met; will collaborate across other business units/departments to ensure coordination of services.
The Senior Manager is accountable for end-to-end management of the Coding, Auditing and QA teams and will provide technical guidance andeducation to medical, management, and administrative staff regarding coding and medical chart review process and support client compliance with CMS rules and regulations, health plan audit requirements and coding guidelines. Some travel is required.
Asa leadership position, this role will also include participation in the Risk Adjustment Leadership Team.
ESSENTIAL JOB FUNCTIONS:

• Works closely with SVP and Sr. Director of Risk Adjustment to develop and implement strategies that improve client deliverables, identify new Risk Adjustment opportunities, and develop and execute overall key metrics to improve coding and auditing performance.
• Collaborates with team managers to evaluate the workload of all team members and determine the need for additional staffing.
• Provides oversight of hiring and onboarding of new team members.
• Delegates effectively and supplies appropriate and adequate oversight resulting in the development of high functioning teams.
• Evaluates team performance and works with team leads/managers to develop improvement measures that meet department standards and ensure a high degree of customer satisfaction.
• Monitor QA accuracy of both internal and external Coders and Clinical and Medical Auditors
• Assists team managers with planning, developing, and directing department policies, programs, and initiatives.
• Collaborates with other members of management to develop new products and expand current Company policies and procedures.
• Ensures contractual obligations are maintained for Coding and Auditing Services.

Senior Level Responsibilities include:

• Works effectively between business lines (such as TPA services and EHR) to ensure optimal operation and identify opportunities for future improvements and road mapping.
• Maintains relationship and communication with Company business partners.
• Researches and provides courteous, accurate and timely response to inquiries by clients/providers as related to Risk Adjustment issues and reports.
• Foster Company and Client relationships, addressing and resolving issues as they arise.
• Supports Risk Adjustment service marketing efforts.
• Creatively assists in developing new business opportunities.
• Reviews bulletins, newsletters, and periodicals, and attends workshops to stay abreast of current issues, trends, and changes in the laws and regulations governing medical ICD-10 CM coding and documentation.
• Understands and adheres to The Health Insurance Portability and Accountability Act (HIPPA) requirements.
• Participates as requested in department meetings, client calls, and annual performance evaluation.
• Performs other duties and responsibilities as required.
• Completes miscellaneous projects for Capstone as assigned or requested.

Departmental Functions:

• Performs retrospective coding reviews as required.
• Supports Clients in proper medical record documentation and HCC reimbursement methodology. Provides technical guidance to medical management and claims staff in identifying and resolving issues or errors, such as incomplete or missing records and documentation, ambiguous or nonspecific documentation, or codes that do not conform to approved coding principles/guidelines; educates and advises staff on codes, documentation, procedures, and requirements; identifies training needs, prepares training materials, and conducts training for physicians and support staff to improve skills in the review and audit of coding quality health data.

The above essential functions are representative of major duties of positions in this job classification. Specific duties and responsibilities may vary based upon departmental needs. Other duties may be assigned similar to the above consistent with knowledge, skills and abilities required for the job. Not all of the duties may be assigned to a position.
QUALIFICATION REQUIREMENTS: These represent the desired qualifications of the ideal candidate. They are not meant to limit consideration for candidates who do not meet all of the standards listed. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
EDUCATION:
Required: Associate degree

• Certified Coding Specialist designation (CCS) issued by the American Health Information Management Association; or, Certified Professional Coder (CPC) or Certified Technologist (RHIT), Certified Registered Nurse Coder (CRN-C)
• 5+ years coding experience (except RHIT) with a minimum of 5 years’ experience with Risk Adjustment Coding (HCC)

Preferred: Bachelor’s degree

• Certified Risk Adjustment Coder (CRC), Certified Coding Specialist designation (CCS) issued by the American Health Information Management Association; or, Certified Professional Coder (CPC) or Certified Risk Adjustment Coder (CRC) or Registered Health Information Administrator (RHIA), or Registered Health Information Technologist (RHIT)

EXPERIENCE:

• Required for Senior Level:
• 7+ years’ experience in Risk Adjustment, preferably in a Medicare Advantage or PACE environment
• Position requires at least three years of experience with Risk Adjustment in a Leadership Role (managing other individuals and teams)
• Preferred:
• Documentation Improvement experience
• Experience in Hierarchical Condition Categories (HCC)
• Knowledge of or experience in Medicare Advantage plans
• Knowledge of or experience in managed health care systems, PACE or Medicare.
• Prior Quality Assurance experience

OTHER SKILLS and ABILITIES: Examples

• Required for Senior Level:
• Strategically manage and consult high risk, high revenue, and complex clients.
• Demonstrated leadership skills.
• Excellent written and verbal communication skills, and professionalism when working with clients.
• Ability to solve problems under pressure by making immediate decisions while on the phone/in-person.
• Experience conducting presentations to groups.
• Detail oriented and able to prioritize workload.
• Strong computer skills including using Word processors, spreadsheets, and database software.
• Ability to manage multiple priorities and work independently.
• Comprehensive understanding and knowledge of department services and products.
• Ability to foster and grow a great work environment to make the company and team a preferred place to work.
• Comprehensive understanding and knowledge of department services and products.
• PHYSICAL/MENTAL DEMANDS:
• Communicates by way of the telephone or computer with providers, participants, customers, and vendors.
• Must be able to commute to multiple site locations.
• Operates a computer and other productivity machinery.
• May sit, stand, stoop, bend and walk intermittently during the day. May sit or stand seven (7) to ten (10) hours per day.
• Visual acuity to perform activities such as identifying, inputting and analyzing data on a computer terminal and/or in hard copy. Specific vision abilities required by this role include close vision, color vision and the ability to adjust focus.
• Occasionally exerts up to 20 pounds of force to lift, carry, push, pull or move objects.
• Ability to reach to retrieve shelved items.
• May be necessary to work extended hours as needed.
• Expected Hours of Work:
• This is a full-time position with an expectation to work an average of 40 hours per week and be available outside of normal business hours to meet customer expectations on an ad-hoc basis. Schedules are set to accommodate the requirements of the position and the needs of the organizationand may be adjusted as needed. This may be considered a hybrid position based on manager discretion.

Travel:

• Ability for overnight travel up to 20%, when necessary.

Supervisory:

• Coding team
• Auditing team
• QA team

The Company is proud to be an equal opportunity employer. All qualified applicants will receive consideration without regard to ancestry or national origin, race or color, religion or creed, age, disability, AIDS/HIV, gender, marital or family status, pregnancy, childbirth or related medical conditions, genetic information, military service, protected caregiver obligations, sexual orientation, protected financial status or other classification protected by applicable law.