Risk Adjustment Coding Manager

Summary

Join Reveleer, a healthcare data and analytics company, as a full-time Clinical Coding Manager to oversee Risk Adjustment and reporting. You will manage medical record reviews, participate in quality improvement, conduct training, monitor project status, and handle various coding projects. This role requires a professional coding certificate, extensive medical records and risk adjustment experience, and strong computer skills. You will be responsible for ensuring accurate code assignment, maintaining clinical knowledge, and safeguarding patient information. Reveleer offers a competitive salary and a commitment to equal opportunity employment.

Requirements

• Must have a professional coding certificate through AHIMA/AAPC
• Minimum of 5 years of hands-on medical records experience
• 5 Years of RISK experience
• Strong computer skills and high-speed internet access at home
• Commitment to confidentiality of patient health information
• Professional, articulate and able to work independently
• Ability to manage teams and meet deadlines
• Be able to conduct trainings in nonstandard time frames to meet abstractor needs and training

Responsibilities

• Oversee and/or perform an accurate medical record review for all RISK
• Support and participate in process and quality improvement initiatives
• Conduct training related to ,RISK, platform usage, up date any training materials, and function as RISK SME
• Monitor project status
• Work on flexible projects with variable client/project specific guidelines
• Review all Negative / Positive hits
• Manage RISK coding projects when needed- including project status and completing chart reviews for coding projects as needed
• Clinical Documentation Review: Analyze medical records and NLP results and validate that the clinical evidence meets the necessary requirements for submission and documentation. This includes making sure the documentation accurately reflects the patient’s conditions, treatment and services provided. Identify gaps, inconsistencies, and discrepancies in documentation that could impact patient care, quality reporting and reimbursement
• Coding Support: Ensure documentation aligns with accurate code assignment and follow CMS’s coding guidelines for HCC risk adjustment coding
• Clinical Knowledge: Maintain a deep understanding of medical terminology, disease processes, treatments, and procedures to accurately interpret and validate clinical documentation
• Documentation Integrity: Safeguard the integrity and confidentiality of patient health information while handling medical records and sensitive data in accordance with HIPAA and other relevant regulations
• Interdisciplinary Communication: Foster clear communication and collaboration between different healthcare departments, ensuring that accurate patient information is shared across the continuum

Preferred Qualifications

Background in UR, QA and/or QI experience preferred

Benefits

• SALARY RANGE: $80,000 - $90,000 / annually
• Remote