Risk Adjustment Client Coding Project Manager

Role Overview

• Maintain a quality assurance program
• 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.

Benefits

• Health insurance
• 401(k)
• Paid time off
• Remote work flexibility
• Professional development opportunities