Risk Adjustment Coding Manager
Group1001 is a consumer-centric, technology-driven family of insurance companies on a mission to deliver outstanding value and operational performance by combining financial strength and stability with deep insurance expertise and a can-do culture. Group1001’s culture emphasizes the importance of collaboration, communication, core business focus, risk management, and striving for outcomes. This goal extends to how we hire and onboard our most valuable assets – our employees.
Clear Spring Health is part of Group One Thousand One (“Group1001”), a customer-centric insurance group whose mission is to make insurance more useful, intuitive and accessible so that everyone feels empowered to achieve financial security. Clear Spring Health is dedicated to helping seniors protect their health and well-being by providing Medicare Advantage plans in select counties of Colorado, Illinois, North Carolina, and Virginia, plus Georgia and South Carolina and offers Medicare Prescription Drug Plans in 42 states plus DC.
Group 1001, and its affiliated companies, is strongly committed to providing a supportive work environment where employee differences are valued. Diversity is an essential ingredient in making Group 1001 a welcoming place to work and is fundamental in building a high-performance team. Diversity embodies all the differences that make us unique individuals. All employees share the responsibility for maintaining a workplace culture of dignity, respect, understanding and appreciation of individual and group differences.
The Risk Adjustment Coding Manager is responsible for developing and maintaining the quality standards, metrics, policies, and compliance for the department and will work with the Analytics/Revenue Team. They will provide oversight of encounter data submissions as well as guidance for the risk adjustment coding department regarding activity, status, trends, and coordination. Coding manager will coordinate strategic planning with preferred provider groups along with network and quality teams.
- Manages all aspects of the Auditing and coding for in-house and/or third party coding teams.
- Manages all aspects of retrospective review process including oversight of third party contracted vendor, chart abstraction projects, and compliance oversight.
- Manages all aspects of prospective risk adjustment process including growing the program with all value based provider groups.
- Responsible for all aspects of Encounter Data Processing System (EDPS) error correction, submissions, and completion.
- Oversight of all provider reporting as it relates to Risk Adjustment including but not limited to capture rate reporting, prospective reporting, projections, submission gap reporting, and overall performance.
- Engage with provider network team in each region regarding specific provider initiatives, clinical meeting, JOC’s etc.
- Create and execute on Risk Adjustment calendar which is centered around submission deadlines.
- Bachelor’s degree
- A minimum of 7 years of experience in risk adjustment coding and/or auditing experience.
- A minimum of 3 years of managing Risk Adjustment team within a Medicare Advantage plan.
- Excellent written and oral communication skills.
- Strong knowledge and skillset in Microsoft Office Suite as well as presentation skills with clinical groups and providers.
- Experience managing the EDPS process as it relates to error corrections within a SaaS based tool.
- Strong managerial, leadership, and interpersonal skills.
- Outstanding organizational skills.
- Strong analytical and problem-solving skills to grasp the key points from complicated details and provide direction/ coaching to members of the team.
- A strong knowledge base of medical terminology, medical abbreviations, pharmacology and disease processes
- Expertise and experience in Risk Adjustment coding
- Ability to analyze data to determine the root cause of identified quality/production concerns
- HIMA certified credentials (RHIA, RHIT, CCS)
- AAPC certified credentials (CPC and CRC)