This position is responsible for the organizational and functional integrity of the risk adjustment coding sections, ensuring staff compliance, development, and education. The incumbent has considerable experience in accurately translating medical terminology into unique and professional diagnostic codes to reflect the health conditions of the member. This position is responsible for the development of coding initiatives and projects along with the coordination and documentation of quality audits of the Risk Adjustment Coders. They will provide feedback to leadership for additional development opportunities of the coders and overall audit status. This position also actively interacts with healthcare professionals to provide risk adjustment education and develop/conduct risk adjustment training for internal/external stakeholders. This position is responsible for keeping abreast of continual changes in coding and billing guidelines and compliance within federal and state regulations. The incumbent is to have an expert knowledge of accurately assigning ICD codes for diagnostic and procedure codes in all levels of care.

Incumbent is responsible for the day-to-day operations of the risk adjustment coding team, ensuring adequate staffing, fair work distribution, and timely and accurate completion of coding tasks. They are responsible for coordinating work schedules, maintaining a calendar of scheduled time off for all employed coding staff. The incumbent will Supervise and lead a team of risk adjustment coding coders, providing guidance, training, and performance feedback. The incumbent will be responsible for generating projects, and workflows for the risk adjustment coding team as well as review and analyzes health records to identify relevant diagnoses and procedures for distinct patient encounters covering a wide variety of clinical cases and services for risk adjustment models. The position is responsible for translating diagnostic phrases utilized by healthcare providers into coded form. The translation process requires interaction with the healthcare provider and critical thinking to ensure that the terms have been translated correctly and to provide education to the healthcare professionals regarding risk adjustment.

The incumbent must have the skill set to:

* Effectively communicate with internal and external stakeholders regarding risk adjustment, i.e., proper documentation, diagnosis specificity, risk adjustable vs non risk adjustable diagnoses, etc.

* Ability to travel to provider offices to conduct risk adjustment education, give feedback to providers regarding documentation/coding, obtain medical records, etc.

* Ensure compliance with CMS (Centers for Medicare & Medicaid Services) guidelines and regulations related to risk adjustment coding.

* Develop and implement coding policies, procedures, and best practices to ensure accuracy, completeness, and efficiency for the risk adjustment coders.

* Conduct regular audits and quality assurance reviews to identify coding discrepancies and opportunities for improvement.

* Collaborate with healthcare providers, medical coders, and other stakeholders to resolve coding-related issues and improve documentation quality.

* Monitor and analyze coding-related data to track performance metrics and identify areas for enhancement.

* Be the primary reviewer of medical records in support of Medicare and Commercial Risk Adjustment audits

* Foster a culture of continuous learning, teamwork, and excellence within the risk adjustment coding department.

* Work both in a team and individual environment with minimum supervision and is confident working with a wide variety of healthcare professionals.

* Consistently meet or exceed productivity and quality standards

* Stay current on the Medicare, Commercial, Federal, and State coding regulations

* Oversee team members' engagement, behavior, and daily activities.

* Conduct interviews, completes new employee onboarding, and successfully trains employees.

The incumbent must have an in depth understanding of the content of the medical record in order to be able to locate information to support or provide specificity for coding. The incumbent must be trained in the anatomy and physiology of the human body and disease processes in order to understand the etiology, pathology, symptoms, signs, diagnostic studies, treatment modalities, and prognosis of diseases and procedures to be coded.

Incumbent will audit/approve time and attendance bi-weekly and monitor staff compliance with Renown Health policies. Incumbent will also monitor staff productivity weekly. Completes employee evaluations and 90 and 180-day progress reports timely, offering developmental plans pertinent to the position and employee growth.

This position does not provide patient care.

The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.

Name

Description

Education:

Must have working-level knowledge of the English language, including reading, writing, and speaking English. An associate or bachelor's Degree is preferred.

Experience:

3-5 years of previous coding experience required. Certified risk adjustment coder and clinical documentation improvement preferred.

License(s):

None

Certification(s):

Ability to obtain and maintain a credential recognized by AHIMA or AAPC is required, this excludes apprenticeship credentials (i.e., CCA or CPC-A)

Computer / Typing:

Must be proficient in Microsoft Office Suite, including Outlook, PowerPoint, Excel, Teams, and Word and have the ability to use the computer for online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.