Lead, Provider 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:

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.

Lead, Provider Risk Adjustment Coding Services

As a member of the CorroHealth team, the Coding Lead utilizes coding knowledge to assist the Director of Coding Services and other members of the Management team in maintaining a high level of client satisfaction through managing the overall quantity and quality of coding production for assigned clients. The candidate will supervise a team of Client Account Coders.

Essential Functions:

Note: The essential duties and primary accountabilities below are intended to describe the general content of and requirements of this position and are not intended to be an exhaustive statement of duties. Incumbents may perform all or most of the primary accountabilities listed below. Specific tasks, responsibilities or competencies may be documented in the incumbent’s performance objectives as outlined by the incumbent’s immediate supervisor or manager.

• Collaborators with global leaders on daily production quantity and quality for each assigned client while maintaining client service level agreement metrics and delivery expectations
• Review pending accounts and second level quality reviews and for errors or assigns to appropriate staff for remediation and completion
• Monitors client reports – production, quality, query compliance, and response and resolves issues as necessary
• Assists in research and resolution of QA disputes and education/trends
• Tests system and workflow changes related to specific client hospitals
• Assist assigned Coding Director with independent responsibilities for client reporting and data analysis
• Recommended staffing modifications and FTEs, assist in overtime planning when necessary
• Recommend and process salary changes/adjustments/promotions as necessary
• Responsible for training assistance of new and existing HCC Coding Specialists
• Participate in and/or lead special projects requiring coding and/or auditing for clients across the organization, as needed
• Develops and communicates coder schedule and resolves changes to schedule
• Assist direct reports with accurate application of diagnosis and procedure codes utilizing CMS/HHS HCC models, ICD-10-CM, ICD-10-PCS, CPT®, and HCPCS
• Provide and/or aid direct reports with interpretation of coding guidelines for accurate code assignment
• Identify and ensure that direct reports understand the importance of documentation on code assignment and the subsequent reimbursement impact
• Align personal conduct with and build a team culture that aligns conduct with AHIMA's Standards of Ethical Coding and the Company’s Code of Ethics and Business Conduct
• Comply with, promote and support direct report’s compliance with all internal policies and procedures
• Actively participate in Company provided training and education and ensure that direct reports complete mandatory training and education by established deadlines and are able to properly implement and/or practice the principles taught via the Company’s training and education program
• Ensure individual and direct report compliance with all privacy and security rules and regulations and commit to the protection of all Company confidential information, including but not limited to, Personal Health Information
• Thoughtfully evaluate risk, participate in the development of risk mitigation activities and engage in correcting deficiencies

Knowledge, Skills & Abilities:

• College degree in healthcare-related field preferred, RHIT or RHIA, or Certified Coding Professional 
• National certification through AAPC or AHIMA required, CCDS or CDIP a plus
• At least 3+ years of previous provider-based risk adjustment coding experience with strong understanding of physician query compliance and composition
• Previous supervisory experience is preferred
• Strong computer skills, proficient in Microsoft Office applications including Word and Excel.
• Ability to navigate in a variety of EMR environments and review hand-written charts
• Strong verbal and written communication skills are required
• Ability to prioritize workload, to meet deadlines and to maintain a high level of quality and accuracy
• Initiative, resourcefulness, and attention to detail
• Regular, predictable, and punctual attendance is required

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.