Coder Program Manager

4 weeks ago

Nashville, United States Leave Your Mark Full time

*Candidate Must Be Based in Nashville, TN or Surrounding Areas


The Coder Program Manager will have organization level responsibilities to lead the risk adjustment program for accountable care populations and MA contracts and facilitate clinical documentation to ensure accurate depiction of the level of clinical services and patient severity through extensive concurrent interaction with physicians and providers.


This role will develop the risk adjustment program strategic roadmap, execute on milestones, monitor performance and outcome metrics, lead performance improvement efforts to achieve program goals The role is responsible for cross functional collaboration with key stakeholders.


What you will do:


•Develop and lead the execution of the risk adjustment strategic workplan to effectively achieve program/contract goals in partnership with physician and operational leadership.

•Drive sustained, measurable improvements in the risk adjustment program across the organization’s Medicare Advantage and accountable care population.

•Serve as content expert on CMS regulations and HCC risk adjustment reimbursement methodology; Interprets, recommends, and communicates operational changes to meet requirements.

•Manage and oversee relationships with vendors and health plans related to the Medicare Advantage and accountable care population's risk adjustment programs to drive program success (analytics, practice management).

•Oversee and advise the implementation of risk adjustment analytics platforms and dashboards.

•Develop and foster relationships with key stakeholders within the risk adjustment process (i.e. Revenue Cycle, Operations, Finance, etc.).

•Serve as a primary resource for risk adjustment data reporting, data analysis, and data interpretation.

•Review and communicate data/metrics with providers at staff meetings and individually.

•Analyze opportunities for programmatic improvement by evaluating effectiveness activities within the program processes.

•Identify, create, and drive educational program needs with providers and operations to support the risk adjustment program.

•Develop and maintain Risk Management/CDI program policies and procedures, consistent with internal policies and current regulatory guidelines.

•Function as the operational business owner for internal and external audits with CMS and any other applicable regulatory, investigative, or government agencies.

•Facilitates improvement in the overall quality, completeness, and accuracy of medical record documentation through extensive interaction with clinicians.

•Identify Clinical Documentation improvement issues and foster excellent communication with physicians, providers, and clinical support staff.

•Provide ongoing Clinical Documentation Improvement education for providers and clinical support staff and educate to new initiatives or identified areas of knowledge deficit.


What you need:

•Baccalaureate degree in nursing, health information management or equivalent preferred

•Certified Risk Adjusted Coder (CRC) required

•Certified Coding Specialist (CCS), or American Academy of Professional Coder (AAPC) Certified Professional Coder (CPC)

•3+ years experience in practice operations, health system, or equivalent

•2+ years HCC/Risk Adjustment experience

•5 years working in a value-based provider group, health plan, and/or vendor contracting with health plans providing annual wellness/risk adjustment services

•5+ years in a leadership role in a capacity developing and implementing risk adjustment, coding, and analytics programs and processes

•Experience working in high-growth environment preferred

•Knowledge of Rev Cycle including various payment structures, fee schedules, and reimbursement methodologies in the outpatient setting and physician encounters

•Knowledge of Medicare programs and regulations including fraud and abuse and Medicare Hierarchical Condition Coding Risk Adjustment

•Knowledge of Medicare/Medicaid rules and regulations regarding CDI, coding, current trends and developments in the area of Clinical Documentation Improvement

•Ability to be an effective change agent

•Ability to communicate clearly via verbal and written communication and convey complex coding concepts

•Effective organizational, critical thinking, problem-solving and decision-making skills

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