ABOUT THE ROLE

This individual will oversee Galileo’s medical coding and risk adjustment operations. We are looking for someone who can work cross-functionally with business operations, product, and other teams to ensure efficiency and compliance of our medical record systems and billing processes. This role will also work with other RCM leaders and teams to oversee and assist with claims processing.

Here’s what you’ll do:

• 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

ABOUT YOU

You should love problem solving and have a knack for making documentation and revenue cycle processes more efficient and quick, while maintaining compliance. You thrive in a growing startup environment and can be adaptable while remaining organized. You are passionate about data and making data-driven decisions.

We would love to hear from you if you have the following or equivalent experience:

• 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.

Compensation

$130,000-$150,000 annually based on experience and market dynamics + equity