• Manager, Risk Adjustment Operations

    Blue KC (Kansas City, MO)


    Guided by our core values and commitment to your success, we provide health, financial and lifestyle benefits to ensure a best-in-class employee experience. Some of our offerings include:

     

    Highly competitive total rewards package, including comprehensive medical, dental and vision benefits as well as a 401(k) plan that both the employee and employer contribute

     

    Annual incentive bonus plan based on company achievement of goals

     

    Time away from work including paid holidays, paid time off and volunteer time off

     

    Professional development courses, mentorship opportunities, and tuition reimbursement program

     

    Paid parental leave and adoption leave with adoption financial assistance

     

    Employee discount program

    Job Description Summary:

    Manages and executes the Blue KC Risk Adjustment (RA) programs for Commercial (ACA). Manages Risk Adjustment coding, auditing and retrieval operations and if needed special projects within the risk adjustment programs.

    Job Description

    + ​​​Manage all risk adjustment coding and chart retrieval activities to support retrospective and prospective retrieval campaigns, regulatory audits, and internal compliance monitoring.

    + ​Accountable for the performance, monitoring and improvement of our risk adjustment coding and chart retrieval operations which at times may include oversight oftemporary coders and/or vendor services.

    + ​Coach and mentor team to achieve production numbers, maintain coding/abstraction/retrieval quality metrics, and comply with CMS/HHS coding guidelines

    + ​Accountable for the oversight of procurement and processing of all medical records needed to support contractual obligations, Government audits and Association requirements.

    + ​Track coding and chart retrieval production and ensureappropriate resources are dedicated to meeting our target production numbers

    + ​Coordinate with internal teams to ensure medical records are accurately processed for coding operations

    + ​Oversee and direct chart coding quality efforts to ensure the appropriate volume of overread/quality audits are conducted and the quality of the audits meets best coding practices

    + ​Act as the SME for our coding abstraction and record retrieval systems and funnel system improvements to technical teams that implement feature enhancements, process workflow enhancements, or operational efficiencies, serve as the administrator to ensure users are properly set up

    + ​Roll out and manage a process to identify areas for our coders to improve their coding documentation techniques and develop / coordinate coding education activities (using internal resources, external coding seminars, and other educational tools)

    + ​Collaborate across internal and external teams for all areas of coding, auditingand retrieval operations and if needed special projects within the risk adjustment programs

    + ​Communicate production numbers, production issues, and if needed propose resolution tactics to address production, system, and/or reporting issues

    + ​Develop policies, procedures, strategies and work methods to achieve department and business goals​​

    Minimum Qualifications

    + ​Bachelor's degree or an equivalent combination of education and experience required to perform the essential functions of the job​

    + 7 years' coding experience​

    + 5 years' risk adjustment experience​

    + CPC required​

    + CRC required within one year of hire

     

    ​​

    Preferred Qualifications

    + RN

    + Strong problem-solving skills

    + Experience working for a health plan and/or within a provider office

    + Experience retrieving data from EMRs (electronic medical records)

     

    Blue Cross and Blue Shield of Kansas City is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to, among other things, race, color, religion, sex, sexual orientation, gender identity, national origin, age, status as a protected veteran, or disability.

     

    At Blue Cross and Blue Shield of Kansas City (Blue KC), we have long put our members first by developing products and services to meet their needs. From our founding in 1938 to more than 80 years of experience in innovative, patient-centered healthcare coverage, Blue KC continues to keep our members at the center of everything we do. As a market leader, we continue to embrace new ideas to make healthcare more affordable and to improve the customer experience. Come join us!

     

    **Blue Cross and Blue Shield of Kansas City will extend reasonable accommodations to qualified individuals with disabilities who are otherwise not able to fully utilize electronic and online job application systems. For assistance, please send an email to** [email protected] .

     

    EOE/Veterans/Disability

     

    Affirmative Action Employer

     

    E-Verify Participation (https://bluekcmemberportal.azureedge.net/pdf/2024/E-Verify\_Participation\_Poster\_Eng\_Es.pdf)

     

    Equal Employment Opportunity/Nondiscrimination/Affirmative Action Policies

     

    IER Right to Work (https://www.e-verify.gov/sites/default/files/everify/posters/IER\_RightToWorkPoster%20Eng\_Es.pdf)

    FMLA

    Employee Polygraph Protection Act (https://www.dol.gov/whd/regs/compliance/posters/eppac.pdf)