RAF Manager

All the benefits and perks you need for you and your family:
• Benefits from Day One
• Career Development
• Whole Person Wellbeing Resources
• Mental Health Resources and Support
Our promise to you:
Joining AdventHealth is about being part of something bigger. It's about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.
Shift : Monday-Friday
Job Location : Virtual
The role you'll contribute:
The RAF Manager will be responsible to design, secure executive commitment, develop and lead a broad and diversified range of risk adjustment coding services for the AdventHealth Population Health Risk Adjustment and CDI Program. This will include but not be limited to developing the overall structure and operations to support programs in Risk Adjustment coding, CDI review, Communication protocols, and Quality Assurance (QA) and compliance programs to effectively meet targeted engagement, clinical and economic outcomes. Ensure that risk adjustment related programs are performing and compliant and in all regulatory mandated and contractual quality activities. Monitor key program and population metrics, as well as participate in quality improvement efforts serving as a risk adjustment coding resource for network physicians, PHSO committees, members, medical services, health management, and member service staffs as well as other internal and external partners. Responsible for actively identifying opportunities of improvement and developing and driving annual clinical initiatives related to the risk adjustment coding management for the populations served. RAF topic educator and training resource to population health services and programs to PHSO and Integrated delivery system partners. Additionally, responsible for reviewing and identifying any opportunities in coding policies and procedures and providing clinical and economic data necessary to make recommendations.
The value you'll bring to the team:

• Responsible for the execution and daily management of the Risk Adjustment Program while, providing leadership and participation in risk meetings as an active member of the team, to discuss policy, strategy, implementation, administration, goals, progress, and improvement of the risk program.
• Manages direct reports in the RAF department
• Assists in setting goals and plan of Risk Adjustment and CDI program (In conjunction with the Director of RAF)
• Assists in training and coaching health plan and clinicians on Risk Adjustment concepts and critical success factors
• Works with compliance, finance, and Quality to ensure compliance with CMS rules and regulations in order to prepare for RADV audits
• Assists in training of health plan staff and providers on proper coding and documentation requirements
• Responsible for education of provider groups on all clinical aspects of risk adjustment including completion of annual wellness visits, and coordinates with the RAF Coding team for evaluation and management of chronic conditions, and identification and documentation of all risk adjustable conditions both historical and suspected conditions.

Qualifications
The expertise and experiences you'll need to succeed:
EDUCATION AND EXPERIENCE REQUIRED :

• Minimum 5 years of experience in RAF coding
• 1 years' experience as a manager/supervisor
• Bachelor's degree in business, health care, or related field.

LICENSURE, CERTIFICATION OR REGISTRATION REQUIRED :
• CDIP, CCDS or CPC (Clinical Documentation Improvement Practitioner/Certified Clinical Documentation Specialist/Certified Professional Coder)