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Risk Adjustment Coding Manager Jobs in Indiana (NOW HIRING)

Humana

Medical Coder

Valparaiso, IN · On-site +1

$18.75 - $25/hr

... Coding Educator 2 identifies opportunities to improve provider documentation and creates an education plan tailored to each assigned provider. Will report to the Manager, Medicare Risk Adjustment As ...

Humana

Medical Coder

Valparaiso, IN · On-site +1

$18.75 - $25/hr

... Coding Educator 2 identifies opportunities to improve provider documentation and creates an education plan tailored to each assigned provider. Will report to the Manager, Medicare Risk Adjustment As ...

Humana

Medical Coder

Valparaiso, IN · On-site +1

$18.75 - $25/hr

... Coding Educator 2 identifies opportunities to improve provider documentation and creates an education plan tailored to each assigned provider. Will report to the Manager, Medicare Risk Adjustment As ...

HHC

Supervisor Professional Coding

Indianapolis, IN · On-site

... adjustments are brought to management's attention quickly so Epic build/adjustments can occur ... coding experience in physician and/or mental health physician office/hospital setting Epic ...

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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.
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Risk Adjustment Coding Manager jobs near you

Risk Adjustment Program Lead

SIHO HOLDING INC

Columbus, IN • On-site

Other

Posted 8 days ago

Job description

Job Title: Risk Adjustment Program Lead
Reports To: Vice President, MyTruAdvantage
The primary responsibility of the Risk Adjustment Program Lead is to serve as the subject matter expert for risk adjustment, maintaining oversight of all risk adjustment activities. This role will support Medicare Advantage and ACA risk adjustment programs.
Brief Description of Duties:
  • Serve as the expert on Medicare Risk Adjustment models; monitor regulatory changes, ensuring adherence to CMS/HHS guidelines
  • Develop and monitor metrics and KPIs to track the success of solutions and improvements; develop dashboards to share risk adjustment trends to key stakeholders; communicate risk adjustment impacts across all levels of the company
  • Conduct comprehensive research and analysis to identify trends and areas of opportunity related to risk adjustment; contribute to the development and implementation of strategic initiatives and a risk adjustment work plan; collaborate with plan partners to leverage a lean team and all possible resources to improve risk adjustment outcomes
  • Responsible for forecasting revenue and collaborating with finance team
  • Create and maintain department policies and procedures
  • Ensure plan readiness and compliance for RAD-V and CMS audits
  • Own vendor oversight of data integration and coding accuracy for Encounter Data Submissions and risk analytics

Minimum Skills Requirement:
  • Minimum of 5 years of experience in Medicare risk adjustment
  • Strong knowledge of CMS risk adjustment models/methodologies and HCC coding
  • Strong analytical, organizational, problem-solving, vendor management, and critical thinking skills
  • Ability to work independently and manage multiple projects involving cross-functional teams and external vendors
  • Ability to interpret and analyze complex data and translate this into meaningful, actionable information
  • High standards of quality and accuracy
  • Advanced skills in Microsoft Excel
  • Commitment to maintaining confidentiality in compliance with HIPAA

All positions are subject to change based on the needs of the business

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