Risk Adjustment Quality Coding Manager - New York, United States - Metroplusjobs

Description

**Risk Adjustment Quality Coding Manager**

**Job Ref:** 74850

**Category:** Professional

**Department:** ANALYTICS AND REPORTING

**Location:** 50 Water Street, 7th Floor, New York, NY 10004

**Job Type:** Regular

**Employment Type:** Full-Time

**Salary Range:** $92, $92,000.00

**About NYC Health + Hospitals**

MetroPlus Health Plan provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

The Risk Adjustment Coding Quality Manager will oversee programs to improve Risk Adjustment coding quality at MetroPlus. Primary responsibilities include designing and carrying out coding quality audits of Risk Adjustment vendors and providers, reviewing member charts to determine additional coding opportunity, and educating internal and external staff about compliant coding. This position will supervise a small team and will serve as a key Subject Matter Expert for both internal and external stakeholders on improving coding accuracy. Must be able to work independently to project manage multiple concurrent coding initiatives.

**Job Description**

Independently design and carry out annual audits of Risk Adjustment vendors to ensure they are

complying with state and federal coding quality guidelines (i.e. Medicare, ACA and Medicaid coding

standards).

Oversee a small team to carry out special coding projects to extract missed diagnosis codes from provider

medical records.

Serve as a key internal Subject Matter Expert on state and federal regulations around accurate Risk

Adjustment coding in the Medicare, Affordable Care Act and Medicaid programs (i.e. HHS-HCC, CMSHCC

and CRG risk adjustment models).

Respond to federal and state audit requests, including Risk Adjustment Data Validation (RADV) requests.

Design and implement Corrective Action Plans when coding deficiencies are identified to ensure highquality

data submissions to CMS and New York State.

**Minimum Qualifications**

6+ years experience as a Risk Adjustment coder at a Health Plan, including working on RADV audits.

Supervisory experience preferred.

Strong understanding of two or more of the following Risk Adjustment models: HHS-HCC

(Commercial), CMS-HCC (Medicare) or CRG (New York State Medicaid).

Up-to-date knowledge of CMS regulations around RADV audits and Risk Adjustment coding.

Experience designing coding audits, calculating results and communicating error rates to key

stakeholders.

Experience designing coding education materials or implementing Corrective Action Plans to address

deficiencies.

Bachelor of Arts degree

**Certified Risk Adjustment Coder qualification or another AAPC/AHIMA certification, such as Certified

Professional Coder (CPC) and/or Certified Coding Specialist Physician (CCS P)**