Manager, Risk Adjustment Coding Operations 110457

St. Louis, MO

Post Date: 07/31/2018 Job ID: 138122 Job Category: Software Dev. - General/IT

Are you looking for a new and challenging opportunity? Do you have experience with medical record audit? Technology Partners can help you make your next big career move a reality.

Our client is currently seeking a talented person for a Manager, Risk Adjustment Coding Operations position in Clayton, Missouri.

What You Will Be Doing:

You will oversee the risk adjustment coding and data validation programs. You will monitor daily queue volumes, prepare executive reports, oversee the coding of risk adjustment audits, develop & support risk adjustment infrastructure and maintain ROI by managing various inputs/outputs. You will also manage daily queue volumes of available medical records in CDMS. You will remain aware of the company's state and line of business LOB specific risk adjustment timelines and regulations to ensure data validations, additional codes, and deleted codes are submitted prior to data submissions deadlines. You will work with the encounters and risk adjustment analytics departments on risk adjustment data submission. You will also work with vendor coding leadership to ensure risk adjustment work being undertaken on behalf of the company meets all state and federal guidelines for risk adjustment code capture and contractual service level agreements. You will oversee quality audits to ensure guidelines set by the state or federal entities are followed, including documentation. You will develop and maintain all policy and procedures for new departmental processes. You will create various reports using EDW and IT Reporting for monthly distribution to executives, vendor coding partners, and the health plans. You will review and approve monthly gap closure reports. You will schedule and attend monthly meetings with the health plans to discuss areas of wasteful and abusive coding. You will also assist in composing provider education for correct coding according to state and federal risk adjustment guidelines.

What We Are Looking For:

  • Bachelor's degree in related field or equivalent experience.

  • 5+ years of medical record audit or related experience.

  • Experience in health plan risk adjustment preferred.

  • Thorough knowledge of administrative, data management and audit functions.

  • Management/supervisory experience preferred.

  • Licenses/Certifications: CPC, CPC-H, CPC-P, CCS, CCS-P, RHIA, or CPMA required. CRC or MARSI risk adjustment certification preferred.

If this position sounds like you, WE SHOULD TALK!

Your better future is ready, and we want to put the right tools in your hands to get you there. Let's go!

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