Risk Adjustment Coding Manager

Summary

Join Reveleer, a pioneering value-based care technology platform, as a full-time Clinical Coding Manager to oversee risk adjustment and reporting. You will oversee and perform accurate medical record reviews, support process improvement initiatives, conduct training on the RISK platform, monitor project status, and manage coding projects. The role requires a professional coding certificate, 5+ years of medical records and risk adjustment experience, and 3+ years of management experience. Reveleer offers competitive pay, comprehensive benefits including medical, dental, vision, 401k matching, disability insurance, PTO, and paid holidays.

Requirements

• Must have a professional coding certificate through AHIMA/AAPC
• Minimum of 5 years of hands-on medical records experience
• 5 Years of RISK and IVA experience
• 3+ years of management 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

• Competitive pay
• Medical, Dental and Vision benefits including HSA/FSA
• 401k with Employer Match
• 100% paid short term and long-term disability insurance
• PTO plan and 10 paid company holidays