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Coding Manager, Risk Adjustment

Columbus, Ohio Job ID 1904148
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Job Summary
The Coding Manager of Risk Adjustment is responsible for managing a team of professional coders to meet the needs of the Medicaid, Medicare, and Marketplace lines of business as it relates to risk adjustment. The Coding Manager is the subject matter expert who researches coding and coding relating issues and reports findings to management, providers and staff while providing direction and leadership to the team

• Assists the Director or Senior Leadership by directly overseeing the day to day work of the Ohio coding team.
• Implements and Monitors progress on all coding initiatives

• Analyzes coder productivity reports and audit findings
• Ensures accountability of the individual coders to quality and productivity standards, and monitoring compliance with corporate policies and procedures.

• Ensures standardization related to risk adjustment coding for all lines of business
• Implements coaching and training plans
• Escalate gaps in projects to Retrospective Director or Senior Leadership
• Management of Medicaid retrospective medical record review processes

• Proven ability to perform strategic planning and priority setting for a coding department.

• Develops processes to ensure complete and accurate coding of assigned product lines.

• Takes responsibility for assignments and demonstrates accountability, discretion and sound judgment in using or managing resources.


Job Qualifications

Required Education
BS Degree in Finance, Healthcare Administration, Business Administration or Health Information Management

Required License, Certification, Association

• 3 years' coding experience in Risk Adjustment
• Proficiency with risk adjustment methodologies
• Understanding of healthcare terminology (CPT, ICD-10)
• Knowledge of coding, HCCs, risk adjustments concepts, medical record review project management, encounter data management, compliance audit concepts
• Strong familiarity and experience with underserved populations

Preferred Experience

• 3 - 5 years management experience
• Experience with risk adjustment data validations or equivalent compliance audits
• Prior experience with CMS risk adjustment projects preferred.

Preferred License, Certification, Association



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