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Manager, Risk Adjustment Coding Operations
Ref No.: 18-17379
Location: Clayton, Missouri
Manager, Risk Adjustment Coding Operations
Clayton, MO
Direct Hire - Permanent Role

What are the 3-4 non-negotiable requirements on this position?Bachelor's degree in related field or equivalent experience. 5+ years of medical record audit or related experience. Experience in health plan risk adjustment preferred. Thorough knowledge of administrative, data management and audit functions. Management/supervisory experience preferred.



Position Purpose: Oversee the risk adjustment coding and data validation programs. Monitor daily queue volumes, prepare executive reports, oversee the coding of risk adjustment audits, develop & support risk adjustment infrastructure and maintain ROI by managing various inputs/outputs.

Manage daily queue volumes of available medical records in CDMS.
Remain aware of company's state and line of business LOB specific risk adjustment timelines and regulations to ensure data validations, additional codes, and deleted codes are submitted prior to data submissions deadlines.
Work with the encounters and risk adjustment analytics departments on risk adjustment data submission.
Work with vendor coding leadership to ensure risk adjustment work being undertaken on behalf of client meets all state and federal guidelines for risk adjustment code capture and contractual service level agreements.
Oversee quality audits to ensure guidelines set by the state or federal entities are followed, including documentation.
Develop and maintain all policy and procedures for new departmental processes.
Create various reports using EDW and IT Reporting for monthly distribution to executives, vendor coding partners, and the health plans.
Review and approve monthly gap closure reports.
Schedule and attend monthly meetings with the health plans to discuss areas of wasteful and abusive coding.
Assist in composing provider education for correct coding according to state and federal risk adjustment guidelines.

Qualifications:

Education/Experience: Bachelor's degree in related field or equivalent experience. 5+ years of medical record audit or related experience. Experience in health plan risk adjustment preferred. Thorough knowledge of administrative, data management and audit functions. Management/supervisory experience preferred.

Licenses/Certifications: CPC, CPC-H, CPC-P, CCS, CCS-P, RHIA, or CPMA required. CRC or MARSI risk adjustment certification preferred.

Client is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.