Director Risk Adjustment and Coding

Overview

The Director of Risk Adjustment and Coding will oversee the development and deployment of a comprehensive risk adjustment and coding reporting program including the analysis, trending of data, data submission and identification of opportunities for complete capturing of patients’ current risk. This role will also lead and mentor a team of managers and coding analysts to help achieve the risk adjustment and coding goals of SWHR while developing and leading the HCC chart auditing program, to ensure accurate and complete capturing of patients’ risk. This includes establishing staff HCC auditing productivity goals, reliability crosscheck to ensure consistency, and implementation of appropriate tools, methods and standards for maximum efficiency for capturing accurate risk. Required Skills & Experience - Bachelor's Degree clinical or related field. Or, Master's Degree clinical or related field - 8 years in Risk Adjustment and Coding to include 4 years in a leadership role (with Bachelor's degree) or, 6 years In Risk Adjustment and Coding to include 4 years in a leadership role (with Master's degree) - 2 years experience working with ambulatory/clinic medical records is preferred - Work requires knowledge of CMS-HCC model and guidelines along with ICD-9/10 and guidelines. Knowledge of medical terminology. Licenses and Certifications - CPC - Certified Professional Coder Or CCS - Certified Coding Specialist upon hire required - CRC - Certified Risk Coder within 12 months of hire What you need to know - Demonstrates continuous performance improvement in advancing the overall risk adjustment and coding program for all ACO contracts. - Remains current on ICD-9/ICD-10 coding, CMS documentation requirements, and State and Federal regulations, including CMS-HCC model and guidelines and Medicare Program requirements for Advantage Health Plans. - Leads the development of key analytics and data to support Risk Adjustment financial forecasts, analysis and reporting to engage key stakeholders and communicate program results to the organization. - Prepares reports and analysis of risk adjustment and coding outcomes data in order to identify opportunities for clinical process improvement initiatives. - Prepares written and oral presentations for a variety of internal and external audiences. - Works closely with the leadership team and clinical and administrative managers to establish compliant coding workflows and standards to improve coding and accurate capturing of patients’ risk. - Collaborates with other PHSC program directors and managers to assess performance monitoring and implement improvement plans, and to ensure accountability, feedback loops and monitoring systems. - Develop, working closely with analytics, other risk score opportunities and a strategy for continual oversight of risk adjustment opportunities across all payers. - Works closely with key clinic leadership when necessary to promote effective communication, facilitating information sharing and collaborative problem solving. - Provides strategic oversight and contributions to key Physician Network and PHSC committees. - Leads the education program for providers and staff in clinics on risk adjustment. and compliant coding practices, including individualized/escalated education, practices improvement plans, utilization of key coding tools, and training and reference materials. - Serves as a training resource and subject matter expert to other team members for questions regarding ICD-9/ICD-10 coding and documentation requirements.

Benefits

Company

This health system is one of the largest faith-based, nonprofit health care delivery systems in the United States. It has 29 hospital locations including 19 acute-care hospital locations, five short-stay hospitals, two behavioral health hospitals, two rehabilitation hospitals and one transitional care hospital, all owned, operated, joint-ventured or affiliated with the system. It has more than 3,900 licensed beds, employs more than 24,000 people, and counts more than 6,000 physicians* with active staff privileges at its hospitals.