Risk Adjustment Operations Manager
- Expired: over a month ago. Applications are no longer accepted.
Privia Health elevates the patient-provider relationship by delivering tools, talent, and technology built to transform healthcare. Our proven, physician-focused platform is designed to reduce unnecessary costs, achieve better outcomes, and improve patient health and provider well-being.
Job DescriptionTitle: Risk Adjustment Operations Manager
Employment Type: FTE
Exemption Status: Exempt
Location: Remote
Overview of the Role:
The Manager, Risk Adjustment Operations is responsible for supporting the growth and improvement of Privia Health’s national risk adjustment (RA) capabilities, including training, education, concurrent coding, and other operational programs. The Manager will develop and enhance the educational program necessary to support value based care initiatives impacting Medicare Shared Savings Programs, Medicare Advantage and ACO contracts. This individual will work in a matrixed organization to deliver complex ideas, support various key stakeholders, and assist with executing new risk adjustment initiatives. They will work closely with multiple markets to build operational action plans and execute to goals, integrating with other relevant teams, such as Population Health, Analytics, and Performance.
The ideal candidate is an expert in coding compliance, knows how to develop strong relationships with internal business partners, and effectively manage business optimization processes to lead a successful team. You will enjoy the flexibility to telecommute. If you are a self starter and driven to succeed, I encourage you to apply.
Primary Job Duties:
Be a partner for strategic innovation, helping key stakeholders understand roadmaps for improvements relating to coding and documentation
Support big-picture thinking to focus business process to improve efficiencies and accuracy relating to risk adjustment
Work with market leaders to understand their unique challenges then develop actionable work plans to implement resolutions
Work with analytics, clinical operations, and performance consultants to understand performance at a National, Market, physician practice, and provider level to identify opportunities for improvement
Assist in collaborating with cross functional teams to develop and execute communication plans impacting risk adjustment program operations
Act as the internal subject matter expert and escalation point for risk adjustment capabilities for market teams and providers
Utilize data analysis for developing ideas, programs and projects
Manage a team of in-market risk adjustment educators conducting activities geared towards improving healthcare outcomes
Ensure HCC Concurrent Coding and Training programs are operating effectively and efficiently
Develop and maintain compliant, centralized training materials, such as webinars, recorded trainings, to support providers and their staff in coding and documentation
Implement risk adjustment programs in new markets as needed
Review and sign-off on all third party developed guidelines
Work effectively with physicians, Non-physician practitioners (NPP), practice staff, health plan/other external parties and Privia multidisciplinary teams
Support RA Educators with ad hoc provider risk adjustment audits
Accurately follow documentation and coding guidelines and legal requirements to ensure compliance with federal and state regulatory bodies
Assist with risk adjustment vendor oversight
Perform other related duties, which may be inclusive, but not listed in the job description
Travel as needed 25% of the time
Minimum Qualifications:
Certified Professional Coder (CPC) required; Certified Risk Adjustment Coder (CRC) preferred
7-10 years’ experience coding ICD-10-CM; Previous experience with Risk Adjustment training
Expert Knowledge of Federal laws and regulations, including NCDs and LCDs affecting risk adjustment documentation and coding compliance
Extensive knowledge of documentation and coding guidelines established by the Center for Medicare and Medicaid Services (CMS) and the American Medical Association (AMA) for assignment of diagnostic and procedural codes
Knowledge of Health care insurance claims practice and compliance
Skilled with MS Office Suite, Electronic Medical Records, Encoder, Coding Clinic, Customer Relationship Management (CRM) or other software programs and internet based applications as needed
Maintain patient, team member and employer confidentiality; comply with all HIPAA regulations
Interpersonal Skills & Attributes:
Able to have honest, difficult conversations with providers about diagnosis documentation and code assignment
Ability to communicate effectively, verbally and in writing
Establish and maintain effective working relationships with providers, management, clients and staff
Excellent interpersonal and presentation skills
Express ideas clearly and effectively
Respond calmly and maturely in high pressure situations
Keep a positive attitude toward company, work, clients, management, and team members
Use a customer focused approach in dealing with conflict and resolution of problems
Physical Demands:
Category Two: Office Operational
Definition: works constantly at a computer or other workstation and performs occasional moderate physical activities
Ability to constantly remain in a stationary position
Ability to constantly operate a computer and other office productivity machinery, such as computer and printer
Ability to read and use close vision, including the ability to do so on a computer screen
Ability to frequently communicate and exchange information
Ability to frequently adjust focus
Ability to move about the office or other locations as needed
Ability to occasionally ascend/descend a ladder
Ability to occasionally position self to maintain computers including under desks and in service closets
Ability to occasionally lift, push, or pull up to 25 pounds of equipment, usually in the form of boxes, equipment or other small packages
All your information will be kept confidential according to EEO guidelines.
Category One: Office Professional
Category Two: Office Operational
Category Three: Field Professional
Category Four: Field Operational
Technical Requirements (for remote workers):
In order to successfully work remotely, supporting our patients and providers, we require a minimum of 5 MBPS for Download Speed and 3 MBPS for the Upload Speed. This should be acquired prior to the start of your employment. The best measure of your internet speed is to use online speed tests like https://www.speedtest.net/. This gives you an update as to how fast data transfer is with your internet connection and if it meets the minimum speed requirements. Work with your internet provider if you have questions about your connection. Employees who regularly work from home offices are eligible for expense reimbursement to offset this cost.
Privia Health
Address
Arlington, VAIndustry
Finance and Insurance
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