Medical Coder - Risk Adjustment Supervisor

Overview

We are seeking a detail-driven and collaborative Risk Adjustment & Coding Manager to support our Senior Comm Unity Care (PACE) programs. This role works closely with SCC Medical Directors and providers to ensure accurate capture and reporting of participant acuity through compliant diagnostic coding. The position plays a critical role in maintaining CMS compliance while directly supporting the financial integrity and performance of our PACE programs.

About the Job: Works in concert with Senior Comm Unity Care (SCC) Medical Directors and providers to ensure an accurate representation of participant acuity is captured through diagnostic coding and reported to CMS. Assists in the development and implementation of systems and processes to ensure the integrity of diagnostic coding and reporting, directly impacting the financial performance and compliance of the PACE programs.

Acts as a liaison between PACE providers and contracted providers to ensure timely response to inquiries and opportunities/findings resulting from audits. Supervision of the Medical Coder - Risk Adjustment Specialist, included but not limited to training, coding backup and auditing.

Medical Coder - Risk Adjustment Supervisor
- Remote

Schedule: M-F 8:00 AM-5:00 PM

Salary: $80,000-$90,000 (Based on Experience)

Monitor and manage Risk Adjustment Specialist

• 100% audit of Risk Adjustment Specialist coding until 95% accuracy is achieved, with continued focused audits monthly.
• Council and educate on VOANS policies and procedures.
• Works closely with Medical Directors and PACE providers to uphold the integrity and accuracy of the risk adjustment reporting process.
• Engages in continuous dialogue with healthcare professionals to ensure that coding accurately reflects participant acuity.
• Create and provide on-site and/or virtual education to new providers regarding optimal documentation practices.
• Create and provide education to all providers regarding coding changes and updates.

Medical Documentation Review and Diagnostic Coding

• Reviews and interprets provider documentation to extract critical information.
• Assigns ICD-10-CM/CPT/HCPCS codes to diagnoses and procedures from documented information in the medical record.
• Assures the final diagnoses and procedures are valid and complete.
• Communicates and resolves coding issues (lacking documentation, provider queries, etc.).
• Acts as a key intermediary between PACE providers and contracted coding services.
• Ensures timely and effective response to coding-related inquiries and issues.

Coding Compliance and Data Analysis

• Facilitates the audit review process, collaborating with providers to resolve individual and systemic coding issues.
• Leads efforts to enhance coding accuracy and compliance through regular, targeted audits.
• Performs data analysis and retroactive audits to uncover and seize missed coding opportunities.

Report Review and Response Process

• Works with clinical leadership to devise and implement procedures for generating and distributing participant specific-reports.
• Ensures these reports are reviewed by the provider during subsequent participant clinic visits, maintaining a system for tracking and ensuring accountability.

Encounter Reporting Support:

• Applies coding expertise to support the accuracy of the encounter reporting process in applicable programs. Acts as a resource for program leadership in determining the appropriateness of coding used for encounters.

Systems and Process Improvement

• Facilitates continuous improvement of systems and processes to better align with the organization’s strategic goals.
• Contributes to the development of initiatives that enhance the efficiency and accuracy of coding practices.

Remote Work and Accountability

• Work independently in remote setting, demonstrating high level of responsibility and accountability.
• Collaborate with cross-functional teams as needed.

Required Qualifications:

• Education:
  
  Associate’s degree in Health Information Management or related field required.
• Certification:
  Current certification as a Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) and Certified Risk Coder (CRC)
• Experience:
  
  Minimum of six (6) years of experience working…