Risk Adjustment Operations Manager

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.

Title: 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.