St. Louis, MO
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.
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.
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