RN Director of Risk Adjustment & Coding

Location: San Antonio, TX
Date Posted: 04-16-2019
RN Director of Risk Adjustment & Coding - Managed Care
San Antonio,TX (Northern Suburb near Airport)

Director of Risk Adjustment & Coding Job Summary:
  • Provides day-to-day oversight of operations for the department.
  • Maintains, revises and implements the medical record review processes and resource/reference tools.
  • Coordinates educational training sessions for market Primary Care Physicians and their staff to ensure federal and regulatory compliance, as well as coding and documentation compliance.
  • Provides monthly reports to senior management. 
  • Monitors staff compliance in regard to departmental policies and procedures to ensure quality outcomes for the company.
  • Monitors and maintains staff productivity and coordinates training for new and existing employees. 
  • Identifies process improvement opportunities for team to ensure quality outcomes in ICD-10 coding and overall process.
  • Provides employee coaching, counseling and evaluation of performance through periodic and annual reviews.  Develops training programs and coordinates training needs for team, new employees and providers and other clinic staff as necessary.
  • Assists with new development and maintenance of the audit application and quality upgrades to the application on an ongoing basis to ensure efficiency in production for clinical coding staff.
  • Assists and the Clinical Research departmental with data mining efforts in recruitment process for clinical research studies
  • Develops and implements objective quality program that ensures compliance with CMS and ICD-10 coding requirements and administers the program in a professional, objective manner as well as ensuring inter rater reliability.
Director of Risk Adjustment & Coding Background:
  • Valid, unrestricted state Registered Nurse (R.N.) license.
  • Requires Bachelor’s Degree in Nursing (BSN) or related field; Master’s degree is a plus.
  • Prefer additional certification as a Coder (CPC) or other Health Information professional.
  • Around 3-5 years of experience in Managed Care coding risk adjustment, project management, operations, or quality improvement required.
  • Roughly 2-3 year’s progressive supervisory experience, leading, supervising, or managing a team or a program/project.
  • Experience with CMS Risk Adjustment submission, RAD-V, analysis and running claims to identify Risk Adjustment gaps.
  • Strong interpersonal skills needed to interact with providers on coding improvement initiatives and identified findings.
  • Strong analytical mind, with problem solving and investigative skills, an aptitude for accuracy, and attention to detail.
  • Must be computer literate and knowledgeable in MS Office and program management software.
  • Possess superior verbal and written communication skills, able to interface with business and medical professionals. 

Manager of Risk Adjustment Benefits: 

This established, nationally-recognized organization is a Fortune 500 company that is committed to the health and happiness of all their staff. They offer a comprehensive benefits package to all full-time, permanent employees including low cost health insurance plan, dental, vision, and life insurance. To assist employees in living a healthier life, they offer either on-site fitness center or discounts to local fitness centers and a comprehensive wellness programs. They also offer free or reimbursed parking, tuition assistance, matching 401(k), employee stock purchase plan, generous PTO plus paid holidays, and much more!

480.269.9491 (CALL – TEXT – FAX)
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