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Posted: 14-Feb-25
Location: Irving, Texas
Internal Number: 253389
Summary:
As the Manager of Risk Adjustment Operations and Education, you will report to the Director of Risk Adjustment Operations. You will be responsible for developing, implementing, and executing a comprehensive Risk Adjustment retrospective and concurrent coding program. In addition, you will oversee the provider education business line. As a manager, you will lead a team of HCC auditors and educators.
Responsibilities:
- Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
- Develops, executes, and maintains HCC comprehensive visit review program to ensure proper documentation of diagnoses and validation of diagnoses with feedback to Providers.
- Collaborates with cross-functional teams to develop relevant coding guidance to the provider population consistent with established coding authorities and in compliance with relevant federal guidance.
- Facilitates appropriate modifications to clinical documentation to accurately reflect patient severity of illness and risk through extensive interaction with Health Partners providers, care management and nursing staff, other caregivers, and the coding staff.
- Maintains knowledge of coding rules and program regulations to ensure the documentation in the patient record accurately reflects all elements impacting the patient risk score thereby contributing to a compliant patient record.
- Reviews data and trends, identifies additional areas of opportunity, communicates findings and recommended solutions, delivers provider-specific metrics, and coaches providers on Gap-closing opportunities as needed.
- Collaborates cross-functionally and assists with preparing data and reports to evaluate the effectiveness and overall impact of the clinical documentation improvement program for presentation to appropriate oversight committees.
- Educates members of the patient care team, including medical staff, on documentation guidelines on an ongoing basis as needed.
- Identifies and assists in the development and implementation of departmental policies and procedures according to established workflows.
- Moves coding functions from "transactional" to "actionable" to drive accurate results.
- Assists with the development, implementation, and oversight of internal and vendor coding projects including ensuring accuracy/coding production satisfies all business needs and contractual requirements.
- Must have the knowledge of CPT, ICD-10, Medicare services and reimbursement methodologies.
- Must have extensive knowledge of Medicare and CMS Risk Adjustment payment rules, regulations, and guidelines.
- Must be able to guide a matrix team to ensure accurate & complete documentation.
- Must have sharp communication and presentation skills, both written and verbal, with the ability to effectively communicate with people at all levels internally and externally.
- Must have effective time-management and project-management skills, including the ability to thoughtfully plan, and interpret complex processes/programs, develop realistic goals/metrics, resolve and/or escalate issues promptly, and ensure adherence to timelines.
- Must have solid collaboration, interpersonal, problem-solving, and coaching skills.
- Other duties as assigned.
Job Requirements:
Education/Skills
Associate degree or 5 years of experience in related risk adjustment programs required.
Experience
- 5 years of related Coding work experience required.
- 5 years of leadership experience required.
Supervising risk adjustment staff and deploying Risk Adjustment programs experience preferred.
Licenses, Registrations, or Certifications
- Certified Risk Coder (CRC) credential required.
- Certified Professional Coder (CPC) credential required.
Work Type:
Full Time
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