Manager, Coding Solutions - Risk Adjustment

 About Us:

Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. 

We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.  

JOB SUMMARY:

We are seeking a highly motivated and experienced Manager, Coding Operations to oversee risk adjustment coding processes. This role will be responsible for managing a team of Team Leads that over a team of medical coders, ensuring compliance with regulatory guidelines, optimizing coding workflows, and driving accuracy in risk adjustment coding operations. The ideal candidate will have strong leadership skills, deep knowledge of medical coding standards (ICD-10-CM, HCC, CPT), and experience with risk adjustment methodologies.

ESSENTIAL DUTIES AND RESPONSIBILITIES: 
Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member.

Key Responsibilities:

• Team Leadership & Management:
  • Lead and manage a team of risk adjustment Team Leads, providing coaching, training, and performance evaluations to support them in leading their team of coders to success.
  • Ensure team adherence to coding guidelines, accuracy, and productivity targets.
  • Develop and implement best practices to enhance efficiency and compliance.
• Risk Adjustment Coding Oversight:
  • Monitor coding operations for accuracy, completeness, and adherence to CMS, HHS, and other regulatory guidelines.
  • Implement risk adjustment strategies to optimize coding outcomes.
  • Conduct audits and quality reviews to ensure proper documentation and coding compliance.
• Compliance & Regulatory Adherence:
  • Stay updated on industry changes, CMS regulations, and coding best practices.
  • Ensure coding operations align with HIPAA, HCC, RADV, and other relevant compliance requirements.
  • Work closely with internal compliance and quality assurance teams.
• Process Improvement & Analytics:
  • Identify opportunities for operational improvements, automation, and efficiency gains.
  • Analyze coding data trends to enhance risk score accuracy.
  • Collaborate with technology teams to optimize coding tools and workflows.
• Collaboration & Communication:
  • Partner with clinical teams, providers, and external stakeholders to enhance documentation and coding accuracy.
  • Prepare reports and presentations for senior leadership on risk adjustment performance and compliance metrics.

Qualifications:

• Education & Certification:
  • Bachelor's degree in Health Information Management, Healthcare Administration, or related field (preferred).
  • Certified Professional Coder (CPC), Certified Risk Adjustment Coder (CRC), or equivalent certification required.
• Experience:
  • 5 years of experience in medical coding, with at least 2 years in a leadership role.
  • Strong background in risk adjustment coding (Medicare Advantage, ACA, Medicaid).
  • Experience with coding compliance audits, HCC capture, and RAF scoring.
• Skills & Competencies:
  • Expertise in ICD-10-CM, CPT, HCC coding guidelines.
  • Knowledge of CMS-HCC, HHS-HCC, and risk adjustment methodologies.
  • Strong leadership, communication, and analytical skills.
  • Proficiency in coding software, EHR systems, and data analytics tools.

PHYSICAL DEMANDS:
Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.