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Risk Adjustment Coding Manager Jobs in Georgia (NOW HIRING)

Oscar Health

Auditor, Risk Adjustment

Atlanta, GA · Remote

$82K - $108K/yr

Quality audits are specific to ICD-10 code abstraction relative to accuracy, completeness, and ... You will report into the Manager, Risk Adjustment. Work Location: This is a remote position, open ...

LCMC Health

... risk adjustment and quality metrics. * Collaborate with Quality, Risk Management, and Case Management to ensure documentation supports patient care initiatives and reporting. * Inpatient Coding ...

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Risk Adjustment Coding Manager information

What are some common challenges faced by Risk Adjustment Coding Managers, and how can they effectively address them?

Risk Adjustment Coding Managers often encounter challenges such as ensuring coding accuracy, keeping up with regulatory changes, and coordinating across multidisciplinary teams. To address these, effective managers implement rigorous quality assurance processes, provide ongoing coder education, and maintain open communication with clinical, compliance, and data analytics teams. Staying updated on CMS guidelines and fostering a culture of continuous improvement are also key strategies for success in this role.

What are the key skills and qualifications needed to thrive as a Risk Adjustment Coding Manager, and why are they important?

To thrive as a Risk Adjustment Coding Manager, you need expertise in medical coding (CPT, ICD-10), risk adjustment methodologies, and a background in healthcare management, often supported by a coding certification such as CPC, CRC, or CCS. Familiarity with coding software, EHR systems, and data analytics tools is typically required. Strong leadership, attention to detail, and the ability to communicate compliance standards effectively are crucial soft skills. These skills ensure accurate risk adjustment coding, regulatory compliance, and improved financial outcomes for healthcare organizations.

What is the difference between Risk Adjustment Coding Manager vs Risk Adjustment Coder?

AspectRisk Adjustment Coding ManagerRisk Adjustment Coder
CertificationsAHIMA or AAPC credentials, management experienceAHIMA or AAPC credentials, coding certification
Work EnvironmentSupervisory role, overseeing coding teamsPerforming coding tasks directly on patient records
Employer & IndustryHealth plans, healthcare providers, insurance companiesHospitals, clinics, health plans

The Risk Adjustment Coding Manager oversees coding teams and ensures compliance, while the Risk Adjustment Coder focuses on accurately coding patient records. Both roles require similar certifications but differ in responsibilities and work environment, with managers handling supervision and coders performing detailed coding tasks.

What are Risk Adjustment Coding Managers?

Risk Adjustment Coding Managers are professionals responsible for overseeing the medical coding process related to risk adjustment in healthcare organizations. They ensure accurate coding of diagnoses and procedures to reflect the health status of patients, which is essential for proper reimbursement from Medicare Advantage and other insurance plans. These managers lead teams of coders, maintain compliance with regulations, and implement quality assurance processes to optimize coding accuracy and organizational performance.
What are popular job titles related to Risk Adjustment Coding Manager jobs in Georgia? For Risk Adjustment Coding Manager jobs in Georgia, the most frequently searched job titles are:
What job categories do people searching Risk Adjustment Coding Manager jobs in Georgia look for? The top searched job categories for Risk Adjustment Coding Manager jobs in Georgia are:
What cities in Georgia are hiring for Risk Adjustment Coding Manager jobs? Cities in Georgia with the most Risk Adjustment Coding Manager job openings:
    Risk Adjustment Coding Manager jobs near you

    Auditor, Risk Adjustment

    Oscar Health

    Atlanta, GA • Remote

    $82K - $108K/yr

    Full-time

    Re-posted yesterday

    Oscar Health rating

    6.9

    Company rating: 6.9 out of 10

    Based on 6 frontline employees who took The Breakroom Quiz

    249th of 299 rated insurance

    Job description

    Hi, we're Oscar. We're hiring a Associate, Risk Adjustment Auditor to join our Risk Adjustment team.

    Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

    About the role:

    The Associate, Risk Adjustment Auditor conducts internal and external quality audits. Quality audits are specific to ICD-10 code abstraction relative to accuracy, completeness, and identified clinical documentation improvement opportunities. You will work with management to implement benchmarks, establish acceptable thresholds, and quality assurance programs.

    You will report into the Manager, Risk Adjustment.

    Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote

    Pay Transparency: The base pay for this role is: $82,717 - $108,566 per year You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

    Responsibilities:

    • Responsible for daily operations pertaining to Risk Adjustment including but not limited to: medical record reviews to report ICD-10-CM diagnosis codes for ACA and MA lines of business, potential Centers of Medicare & Medicaid Services (CMS), Health and Human Services (HHS) audits and medical record retrieval efforts.
    • Mitigate risk by validating Encounter Data Gathering Environment Server (EDGE) data is supported within provider encounter documentation
    • Review the performance of the Risk Adjustment Coding team and report audit trends to Leadership in a timely, consistent and effective manner to ensure the appropriate changes and education are implemented.
    • Maintain compliance with national standards and coding practices set by the ICD-10-CM coding guidelines for accuracy, as well as compliance with Risk adjustment production standards.
    • Conduct CMS audits of Risk Adjustment activities, including but not limited to Risk Adjustment Data Validation audits.
    • Develop relationships with key individuals to foster an increased understanding of the Risk Adjustment process.
    • Identify and execute on the creation of clinical document improvement resources for provider education in both MA and ACA line of business.
    • Manage the implementation process improvements that will maximize risk adjustment factor increases.
    • Compliance with all applicable laws and regulations
    • Other duties as assigned

    Requirements:

    • Bachelor's degree in a relevant field of study or commensurate work experience.
    • Certified professional coder (CPC)
    • 3+ year(s) retrospective risk adjustment coding experience.
    • 1+ year(s) experience Quality Auditing and/or Risk Adjustment Data Validation Audit (RADV) experience

    Bonus points:

    • Certified Risk Adjustment Coder (CRC) or similar certification
    • Experience coding in a variety of different Electronic Medical Record (EMR) systems.

    This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.

    At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

    Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

    Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.

    Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.

    California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.

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