Play a key role in ensuring coding compliance and accuracy
Monitor the performance of the Risk Adjustment Operations both internally and with coding vendors
Provides expertise as it relates to coding compliance for new and existing services, while ensuring compliance with organizational, federal, state, and third-party requirements.
Assist in the methods to effectively communicate information through presentations, reports, educational programs, memoranda, etc. by providing formal and informal education to QA specialists, coding vendors and staff.
Report findings to Leadership in a timely, consistent and effective manner ensuring that appropriate changes are implemented.
Support audit processes ensuring work flows and results are properly documented and maintained. Identify process improvements as needed.
Assist in the development of an effective training program regarding correct coding techniques/practices
Assist with training new auditors and training of other staff as needed.
Create methods to share information on the program, quality, and initiatives with Management on a monthly cadence at minimum.
Perform other duties as assigned
Requirements
Bachelor’s degree in relevant field of study preferred or 3-5 years related work experience coder with a minimum of 5 year's coding experience in risk adjustment both ACA and MA.
Expert knowledge of Risk Adjustment.
Research and problem resolution skills.
Exceptional interpersonal relationship skills.
Must possess strong managerial, financial, and analytical skills.
Consistent demonstration of commitment to quality, customer focus, productivity, and process improvement.
Strong communication skills to effectively interact all levels of the organization, business unit leaders, and staff in a tactful and positive manner.
Experience overseeing remote (Work at Home) operations.
Exceptional interpersonal skills, proven success in complex and ambiguous environments.
Ability to work independently, with high productivity, and regularly meet deadlines.
Demonstrates excellent written and verbal communication skills conforming to all rules of punctuation, grammar, diction and professional style.
Experience in initiating, developing and monitoring policies, internal control procedures and operating standards.