Medicare Risk Adjustment Coding Manager

Job Summary

Leading initiatives to enhance healthcare quality, the full-time salaried Medicare Risk Adjustment Coding Manager will coordinate Risk Adjustment and Quality coding operations, oversee chart review programs, and manage vendor operations while working remotely from NY, NJ, or CT.

Key responsibilities

• Coordinate Risk Adjustment and Quality coding operations with a focus on documentation integrity
• Oversee retrospective and prospective chart review programs and manage day-to-day vendor operations
• Act as the operational bridge between Risk Adjustment and the HEDIS/Quality abstraction team to improve HCC accuracy and quality measures

Required qualifications

• CPC, CPMA, CRC, CCS-P, CCS, RHIA, or RHIT certification
• At least five years of experience in Medicare Risk Adjustment coding, including familiarity with RADV audits
• Proficiency in HEDIS measure specifications and quality gap closure operations preferred
• Strong knowledge of ICD-10 and CPT codes, along with experience using electronic medical record systems
• Bachelor's degree in Business Administration, Finance, or a relevant field, or equivalent work experience