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Risk Adjustment Coding Manager Jobs in Iowa (NOW HIRING)

Thedacare

Coding Educator

Carroll, IA · On-site

$26.25 - $29.75/hr

... adjustment diagnosis) for professional services including specialty medical services, in and ... Creates mitigation plan to reduce future risk. * Manages and maintains coding inventory ...

Urrly

Telehealth Nurse Practitioner

Des Moines, IA · On-site +1

$600 - $720/day

... HCC risk adjustment during patient visits * Close HEDIS (quality measures) care gaps * Review medical history, medications, and preventive needs * Document visits using ICD-10 and CPT II codes

Thedacare

Coder (Clinic - III)

Carroll, IA · On-site

$18 - $24/hr

... adjustment diagnosis) for professional services including specialty medical services, in and ... Creates mitigation plan to reduce future risk. * Manages and maintains coding inventory ...

Thedacare

Coding Auditor

Manchester, IA · Remote

$24.50 - $28/hr

Responds to identified areas of risk through investigation and internal audit to ensure compliance ... Assists in the development and management of learning management systems and compliance training ...

Varsity Tutors

Finance Tutor

Ames, IA · Remote

$18 - $40/hr

... risk adjustment in valuation, and interpreting financial ratios. Adapts instruction using financial ... management courses. * Effective Teaching Methods: Ability to identify concepts students commonly ...

Varsity Tutors

Finance Tutor

Iowa City, IA · Remote

$18 - $40/hr

... risk adjustment in valuation, and interpreting financial ratios. Adapts instruction using financial ... management courses. * Effective Teaching Methods: Ability to identify concepts students commonly ...

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Risk Adjustment Coding Manager information

What is a risk adjustment coding manager?

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 the key skills and qualifications needed to thrive as a risk adjustment coding manager?

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 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 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 popular job titles related to Risk Adjustment Coding Manager jobs in Iowa?

For Risk Adjustment Coding Manager jobs in Iowa, the most frequently searched job titles are:

What job categories do people searching Risk Adjustment Coding Manager jobs in Iowa look for?

The top searched job categories for Risk Adjustment Coding Manager jobs in Iowa are:

What cities in Iowa are hiring for Risk Adjustment Coding Manager jobs?

Cities in Iowa with the most Risk Adjustment Coding Manager job openings:

Risk Adjustment Coding Manager jobs near you

Consulting Actuary - ACA Risk Adjustment

Blue Cross and Blue Shield of North Carolina

Des Moines, IA • On-site

$143K - $229K/yr

Other

Medical, Dental, Vision, Retirement, PTO

Re-posted 26 days ago

Blue Cross and Blue Shield of North Carolina rating

7.8

Company rating: 7.8 out of 10

Based on 13 frontline employees who took The Breakroom Quiz

196th of 315 rated insurance

Job description

Job Description

As a Consulting Actuary -ACA Risk Adjustment, you will play a pivotal role in delivering a wide array of actuarial and analytical services for our organization. Responsibilities include leading pricing strategies and actuarial initiatives for business segments, evaluating advanced care management models, conducting competitive benchmarking analyses, and designing and pricing sophisticated insurance products. You will support company objectives by providing reliable, actionable actuarial insights and recommendations, proactively identifying and addressing complex risks and opportunities. This position requires adaptability to the evolving landscape of the industry, ensuring our actuarial practices remain at the forefront of innovation and excellence.

What You'll Do

  • Accountable for completion of complex actuarial or analytical projects, ensuring timeliness, compliance, and quality of work

  • Provide proactive and strategic thought leadership of ways to improve processes, reduce risks, and meet department and enterprise objectives to achieve profitable growth and/or improve value, quality, and access for Blue Cross NC customers

  • Achieve segment financial targets and provide concise explanations of results and variances to expectations; act as a financial steward for the company

  • Communicate effectively with all levels and divisions within the organization, including Divisional Leadership

  • Manage external partnerships with vendors, auditors, regulators, and health care providers, including effective negotiation of contracts and/or rates

  • Develop and maintain strong business relationships with internal partners through business expertise and exceptional support; act as a strategic advisor

  • Meet continuing education standards required for job function, thought leadership and maintenance of actuarial credentials

What You Bring

  • Bachelor's degree or advanced degree (where required)

  • Member of the American Academy of Actuaries

  • Fellow of the Society of Actuaries

  • 7 years of relevant actuarial experience, related experience may be considered.

  • In lieu of an FSA, will consider candidates who are an Associate of the Society of Actuaries (ASA) and have at least 9 years of relevant actuarial experience.

Bonus Points

  • Deep experience with ACA Risk Adjustment, including HHS-HCC model methodology, risk score forecasting, and financial impact analysis - Highly Preferred

  • Proven expertise in ACA Risk Adjustment transfer forecasting and explanation of results to senior leadership - Highly Preferred

  • Strong understanding of diagnosis coding (ICD-10-CM), provider documentation practices, and their impact on risk adjustment outcomes.

  • Advanced analytical skills to identify risk adjustment leakage, emerging risks, and optimization opportunities across ACA populations

What You'll Get

  • The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community.

  • Work-life balance, flexibility, and the autonomy to do great work.

  • Medical, dental, and vision coverage along with numerous health and wellness programs.

  • Parental leave and support plus adoption and surrogacy assistance.

  • Career development programs and tuition reimbursement for continued education.

  • 401k match including an annual company contribution

  • Learn more

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs.Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.

*Based on annual corporate goal achievement and individual performance.

$143,616.00 - $229,786.00

Skills

Actuarial Analysis, Actuarial Management, Actuarial Science, Actuarial Services, Affordable Care Act (ACA), Complex Care Management, Financial Reporting and Analysis, Hiring Management, Insurance Industry, Organizational Leadership, Regulatory Compliance

_____________________________________________________________________
JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on https://bcbsnc.wd5.myworkdayjobs.com/en-US/BCBSNC. If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: HR.Staffing@BCBSNC.com.

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