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Job Title

Risk Adjustment Coding Manager

Requisition #

24887

Exemption Status

Exempt

Management Level

Manager

Direct Reports

Coding Auditors

Manager Title

Director, Risk Adjustment

Pay and Benefits

Estimated hiring range $109,500 - $133,840 / year, 5% bonus target, full benefits. www.careoregon.org/about-us/careers/benefits

Posting Notes

This position is primarily remote, with occasional in-office requirements. You must reside in Oregon or Washington.

Job Summary

The Risk Adjustment Coding Manager is responsible for the development, execution and management of the risk adjustment coding and provider education programs for the Medicare Advantage and Medicaid product lines. This function is highly visible, matrixed to multiple departments, including Medicare, Compliance, Finance, and Clinical Services, and is responsible for ensuring a high degree of quality, coordination, and collaboration across the entire risk adjustment process.

Essential Responsibilities

Coding Education

+ Manage the company’s risk adjustment coding and provider education activities and monitor performance against goals.

+ Partner with contracted clinics and Clinical Innovation team to establish clinic and EMR workflows and education programs in support of coding accuracy and completeness initiatives.

+ Establish cross-functional team to share identified coding opportunities and plan for communication with clinical partners.

+ Build feedback and monitoring process with clinic partners for sharing provider education and tracking progress toward goals.

Chart Review & Vendor Oversight

+ Develop and oversee coding team productivity standards using Key Performance Indicators (KPIs) to drive operational execution of the coding team including tracking and managing productivity of coding auditor work and provider education.

+ Develop and manage chart retrieval projects for prospective, concurrent and retrospective chart review programs.

+ Serve as Account Manager for coding and provider education vendors, managing the relationships and monitoring performance against service level agreements.

Compliance Program

+ Project manage all audits including but not limited to Risk Adjustment Data Validation (RADV).

+ Use analytics to identify potential risk adjustment compliance risks.

+ Serve as source of truth for CareOregon Risk Adjustment coding guidelines and provider education materials.

+ Maintain an expert level of knowledge of Medicare and HCC risk-based reimbursement methodologies, policies and best practices.

Miscellaneous

+ Attend industry risk adjustment training and assimilate learning into processes.

+ Participate in risk adjustment workgroups and other related policy advocacy.

+ Develop and/or recommend risk adjustment policies and procedures, guide process improvement and implementation.

+ Complete other work and special projects as assigned.

Employee Supervision

+ Manages team(s) and recommends team direction and goals in alignment with the organizational mission, vision, and values.

+ Identifies work and staffing needs to meet work expectations; recruits and hires, using an equity, diversity, and inclusion lens.

+ Plans, organizes, schedules, and monitors work; ensures employees have information and resources to meet job expectations.

+ Leads the development, communication, and oversight of team and individual goals; ensures goals, expectations, and standards are clearly understood by staff.

+ Trains, supervises, motivates, and coaches employees; provides support toward employee development.

+ Incorporates guidance from CareOregon equity tools into people leadership, planning, operations, evaluation, and decision making.

+ Ensures team adheres to department and organizational standards, policies, and procedures.

+ Evaluates employee performance and provides regular feedback to support success; recognizes strong performance and addresses performance gaps and accountability (corrective action).

+ Performs supervisory tasks in collaboration with Human Resources as needed.

Organizational Responsibilities

+ Perform work in alignment with the organization’s mission, vision and values.

+ Support the organization’s commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals.

+ Strive to meet annual business goals in support of the organization’s strategic goals.

+ Adhere to the organization’s policies, procedures and other relevant compliance needs.

+ Perform other duties as needed.

Experience and/or Education

Required

+ Minimum 7 years’ experience as certified coder

+ Certified Risk Adjustment Coder (CRC), Certified Documentation Improvement Practitioner (CDIP) or Certified Documentation Expert Inpatient or Outpatient (CDEI or CDEO)

Preferred

+ Minimum 2 years’ experience in a supervisory position or minimum 1 year experience in a supervisory position with completion of CareOregon’s Aspiring Leaders Program

+ Bachelor’s degree in related field

Knowledge, Skills and Abilities Required

Knowledge

+ Extensive knowledge of diagnosis code conventions as defined by CMS and AMA

+ Knowledgeable of CDPS+Rx and CMS Risk Adjustment regulations

Skills and Abilities

+ Advanced ability to read and comprehend medical terminology and medical chart notes

+ Advanced ability to work proficiently with electronic health record (EHR) software systems

+ Strong computer skills, including ability to learn new systems and applications as needed

+ Strong skill and ability to use Microsoft Office products (PowerPoint, Excel, Word, etc.)

+ Advanced analytical, problem-solving and research skills

+ Proficient written and spoken communication skills

+ Advanced ability to effectively teach and coach adult learners and communicate technical information clearly

+ Advanced ability to present information to groups, including medical professionals

+ Strong attention to detail and problem-solving skills

+ Ability to work autonomously with a high degree of initiative

+ Ability to work well under pressure, remain focused and meet deadlines

+ Ability to use good judgment and discretion to perform job responsibilities

+ Ability to work effectively with diverse individuals and groups

+ Ability to learn, focus, understand, and evaluate information and determine appropriate actions

+ Ability to accept direction and feedback, as well as tolerate and manage stress

+ Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day

+ Ability to hear and speak clearly for at least 3-6 hours/day

Working Conditions

Work Environment(s): ☒ Indoor/Office ☒ Community ☐ Facilities/Security ☐ Outdoor Exposure

Member/Patient Facing: ☒ No ☐ Telephonic ☐ In Person

Hazards: May include, but not limited to, physical and ergonomic hazards.

Equipment: General office equipment

Travel: May include occasional required or optional travel outside of the workplace; the employee’s personal vehicle, local transit or other means of transportation may be used.

Work Location: Work from home

#Li-Remote

Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment.

Veterans are strongly encouraged to apply.

We are an equal opportunity employer. CareOregon considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or veteran status.

Visa sponsorship is not available at this time.