Manager, Risk Adjustment Coding Operations

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POST DATE 8/31/2016
END DATE 12/19/2016

MMS Group Atlanta, GA

MMS Group
Atlanta, GA
AJE Ref #
Job Classification
Full Time
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Manager, Risk Adjustment Coding Operations - Atlanta, GA

Newly-created position! Fortune 500 Healthcare Enterprise is growing exponentially in the Georgia market.
Experienced manager will oversee the risk adjustment coding and data validation programs. Monitor daily queue volumes, prepare executive reports, oversee the coding of risk adjustment audits, develop & support risk adjustment infrastructure and maintain ROI by managing various inputs/outputs.

* Manage daily queue volumes of available medical records in CDMS.
* Remain aware of company's state and line of business LOB specific risk adjustment timelines and regulations to ensure data validations, additional codes, and deleted codes are submitted prior to data submissions deadlines.
* Work with the encounters and risk adjustment analytics departments on risk adjustment data submission.
* Work with vendor coding leadership to ensure risk adjustment work being undertaken on behalf of corporation meets all state and federal guidelines for risk adjustment code capture and contractual service level agreements.
* Oversee quality audits to ensure guidelines set by the state or federal entities are followed, including documentation.
* Develop and maintain all policy and procedures for new departmental processes.
* Create various reports using EDW and IT Reporting for monthly distribution to executives, vendor coding partners, and the health plans.
* Review and approve monthly gap closure reports.
* Schedule and attend monthly meetings with the health plans to discuss areas of wasteful and abusive coding.
* Assist in composing provider education for correct coding according to state and federal risk adjustment guidelines.


- Bachelor's degree in related field or equivalent experience.
- 5+ years of medical record audit or related experience.
- Must have experience in health plan risk adjustment
- Thorough knowledge of administrative, data management and audit functions.
- Management/supervisory experience preferred.

Licenses/Certifications: CPC, CPC-H, CPC-P, CCS, CCS-P, RHIA, or CPMA required.
CRC or MARSI risk adjustment certification preferred