Search Page | Back to Results

Supervisor, Risk Adjustment

Network Health is seeking a supervisor of risk adjustment. This individual will oversee the Network Health/Network Health Insurance Corporation (NH/NHIC) Risk Adjustment coding and auditing effort. The Supervisor is responsible for the development and tracking of both internal and external risk adjustment coding and auditing programs. The Supervisor is responsible for the leadership and development of the Risk Adjustment coding associates, including supervision, training and performance management, consulting with Human Resources and Risk Adjustment leadership as appropriate.

The Supervisor will facilitate and conduct clinical based audits for the purpose of identifying and submitting documented diagnoses to CMS for members of NH/NHIC’s Medicare Advantage (MA) and Affordable Care Act (ACA)-qualified products. In addition, this position will interact with internal and external customers including administration, physicians, practitioner office staff as well as outside vendors. The Supervisor is responsible for oversight of the Risk Adjustment compliance plan, the audit program and the completeness and accuracy of Network Health’s ICD-10 HCC data submitted to CMS/HHS, following mandated Federal or State coding regulations and guidelines.

Job Responsibilities:
• Performs day to day supervision of the internal coding staff including hiring, performance management, recognition and development. Coordinates staff schedules to ensure staffing levels meet business needs.
• Develop processes to ensure complete and accurate coding and data submission of NH/NHIC Medicare Advantage and ACA-qualified members.
• Performs audits on internal and external resources and develops Corrective Action Plans as needed.
• Coordinates/performs CMS/HHS required audits.
• Develop standardization of audit policies, processes and guidelines.
• Manages, coordinates and evaluates the Risk Adjustment Audit and Compliance plans.
• Development of comprehensive ICD-10 coding and documentation initiatives, with an emphasis on chronic health conditions
• Track implementation of programs related to HCC activities and high-risk patients, ensuring that those members have appropriate medical record documentation and corresponding risk score.
• Develop and maintain a compliant internal and external audit review plan, to include the auditing and managing of contracted vendor activities.
• Other duties as assigned

Job Requirements:
• Associate Degree or equivalent experience required.
• 6+ years’ experience working in a coding or similar position required.
• 3+ years’ experience working in HCC coding, auditing and/or risk adjustment operations required.
• 1+ years’ experience in a leadership role required, preferably in the healthcare industry.
• Prior risk adjustment RADV audit experience strongly preferred.
• Certified Coder credentials required (CPC, COC, CIC, or AHIMA certification).
• Certified Risk Adjustment Coder (CRC) credentials strongly preferred.

Time:  Full time
Salary:  Salary
Category:  Finance

Updated: 9/12/2019 1:51:02 PM

Job Contact:
Jackie Rosen
9207201723

Send Resume

1570 Midway Pl
Menasha, WI 54952

9207201723