Director, Risk Adjustment and Coding

Product San Francisco, CA


Description

 

POSITION DESCRIPTION

Director, Risk Adjustment and Coding

Talix, Inc.

 

 

JOB DESCRIPTION

 

We are looking for an experienced Director, Risk Adjustment and Coding that will play a critical role in disrupting the multi-billion dollar healthcare risk adjustment market.

We are looking for a Director, Risk Adjustment and Coding that is both tactical and strategic and can lead a broad array of activities, including (a) providing regulatory and domain expertise in guiding product development activities (b) serving as a trusted advisor and subject matter expert to our customers and prospects (c) helping refine our NLP engine and coding rules to continue to be the market leading NLP enabled Risk Adjustment platform

 

If you are a Risk Adjustment expert and want to work on innovative NLP enabled solutions for payers and providers and help them improve their Risk Adjustment processes, Talix is the place!

 

RESPONSIBILITIES

 

  • Serve as a domain and subject matter expert on Risk Adjustment and Coding. Stay updated on current and emerging regulatory changes as it relates to Risk Adjustment, Coding and RADV audits
  • Work closely with customers and prospects by serving as a trusted advisor and helping train them in successfully adopting the application to support their coding operations
  • Work with our coding services partners and associated QA processes to successfully deliver coding services to our customers
  • Collaborate with Talix’s Clinical Informatics, Taxonomy and Product teams to define clinical rules to improve NLP engine accuracy
  • Work with product managers and interaction designers to identify optimal user experiences and features within the application so that it can be seamlessly integrated into existing coding workflows.

 

CANDIDATE QUALIFICATIONS

 

  • 6+ years professional risk adjustment coding experience at a health plan (must have experience working as a coder or code auditor)
  • 4+ years managerial experience in managing a risk adjustment coding team or coding department
  • 3+ years provider outreach and clinical documentation improvement (CDI) experience in risk adjustment
  • National coding certification from AAPC or AHIMA to include one or more of the following: Certified Professional Coder (CPC), Certified Risk Adjustment Coder (CRC) and/or Certified Coding Specialist Physician (CCS P)
  • Inpatient and outpatient coding knowledge and experience with ICD-9 and ICD-10 coding.
  • Some familiarity with SNOMED CT or other structured medical terminologies.
  • Excellent knowledge of coding guidelines and risk adjustment regulatory initiatives.
  • Experience with RADV or RAC audit processes.
  • Understanding of decision logic and billing/coding logic.
  • Strong analytical skills
  • Excellent verbal and written communications and interpersonal skills.
  • Ability to work in a fast paced environment. Possess a “do what it takes” attitude and a strong work ethic.
  • Must be self-directed, willing to work independently and comfortable taking the lead on resolving issues that span multiple groups or team members.

 

About Talix

 

Talix delivers intelligent data analytics that enable healthcare organizations to turn structured and unstructured health data into actionable insights that drive improved risk adjustment and better patient outcomes. For more company information, visit talix.com