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Risk Adjustment Coding Supervisor

Job Type : Direct
Hours : Full Time
Required Years of Experience : 3-5
Required Education : Bachelorís Degree in Healthcare or related field
Travel : No
Relocation : No
Job Industry : Healthcare - Health Services
Job Category : Healthcare - Other

Job Description :
Job Nature:


Responsible for the administration the coding for the Medicare operational area of the risk adjustment process and encounter data processing (EDPS) in accordance with CMS regulations. Provides oversight and leadership to the coding department to ensure initiatives are aligned to support the goals and objectives of the organization. Monitor and oversight vendor performance and contract. Shapes team priorities to reflect the organization’s vision and values.


Duties and Responsibilities:

  • Establish the goals and objectives of the coding Medicare operational area of risk adjustment process in accordance with CMS regulations.

  • Develop and implement strategies to ensure coding accuracy for CMS submission.

  • Align providers on revenue management strategy. In coordination with providers department, establish the plans and activities to ensure compliance.

  • Responsible for identifying, managing, and implementing strategic initiatives to accurately reflect risk adjustment revenue, and minimize RADV exposure.

  • Provide coding support, education and training related to, quality of documentation, level of service and diagnosis coding consistent with established CMSI guidelines and standards.

  • Identify corrective actions plans and implement strategies related to coding finding.

  • Provide guidance and oversight for internal coding reviews in compliance with internal review process.

  • Oversees the implementation of data management controls to ensure data quality and integrity, developing tracking, validation, and reporting tools.

  • Provide regular updates to the management on the status of their completed reviews.

  • Oversees risk adjustment data validation audits by government agencies or outside audit vendors, aiding internal stakeholders and conduct medical record chart reviews to validate diagnoses.

  • Perform claims and medical record reviews with focus on accuracy of diagnoses, as needed to respond to issues, as part of regulatory audit, or as element of oversight audit.

  • Establishes operating policies and procedures for all risk adjustment programs and processes in coordination with internal and external operational units. Ensure employees follows guidelines, policies, and procedures accordingly.

  • Establish clear and efficient processes for the monitoring of the Risk Adjustment Process.

  • Organize and Implement specific projects aimed to achieve operational and regulatory excellence. In coordination with IT and Compliance, establish the activities and action plans to meet project timelines.

  • Participates in the implementation of tactical plans, follows up on assigned tasks, projects, or objectives to ensure that expectations are met.

  • Prepares production reports, statistics and presentations when required.

  • Assist in special projects and / or initiatives of the corporation.

  • Provide recommendations to achieve the Division’s and Company’s goals.

  • Interview, recommend, trains, coaches, counsels, motivates, and evaluates the performance of direct reports. Establishes disciplinary actions when necessary and promotes employee performance recognition
    when applicable.

  • Responsible for preparing, assigning tasks, monitoring workflow and monitor day to day execution and
    employee activities.

  •  Other tasks as assigned by management and that are essential.

Required Qualifications :

  • Bachelor’s Degree (Master’s degree is a plus) in Healthcare or related field with three (3) to five (5) years in the insurance and health industry.

  • One of the following professional certifications from AHIMA or AAPC: Certified Professional Coder (CPC), Certified Coding Specialist (CCS or CCS-P), Certified Inpatient Coder (CIC), Certified Outpatient Coder (COC), Certified Risk Adjustment Coder certification (CRC).

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