Director – Coding & Risk Adjustment
Posted on 11/1/2023
Remote in USA • New York, NY, USA
Experience Level
Desired Skills
Data & Analytics
  • 5+ years in a Medicare risk adjustment coding leadership role is a must. Experience in Commercial / ACA and Medicaid Risk adjustment
  • 3+ years analyzing risk adjustment data, comprehensive understanding of cohort analysis, diagnosis prevalence, suspected gap logic
  • Experience in the Risk Adjustment Data Validation (RADV) rebuttal process would be highly preferred, but basic experience with an audit or mock audit (healthplans mocks) is extremely helpful
  • Ability to perform internal audits for both E/M and Risk Adjustment, to include creating improvement plans, communicating audit results / next steps to providers, and presenting audit results to executive leadership
  • Working knowledge of regulatory requirements pertaining to health care operations and their impact on cross functional organizational operations
  • Experience in multiple EHRs
  • Experience overseeing departmental charge capture, reconciliation, denials management, A/R management and reporting
  • CPC, CCA, or CCS certifications required
  • Oversee and operationalize coding and CDI programs to drive best practices for complete and accurate documentation of patient health status
  • Lead revenue cycle strategic planning and execution, and implementation of standardized processes and procedures
  • Lead education programs for clinicians on coding/documentation best practices
  • Partner with product, engineering, and data teams to optimize revenue cycle and risk adjustment initiatives
  • Oversee compliance and appropriate audit programs for all coding and CDI practices
  • Interpret data, financial metrics and provide reporting to executive leadership
  • Work with organization leaders to develop KPIs, performance dashboards, and reporting to drive operational performance
  • Contribute to the design of a proprietary EHR to support both coding and documentation best practices, and ensure compliance and regulatory standards are met
  • Implement, and manage vendors for outsourced coding services
  • Answer coding questions, provide documentation recommendation and best practices in a realtime environment