Risk Adjustment & Quality Manager is responsible for developing,
implementing and maintaining physician, mid-level and CPC coder
patient medical record coding for disease burden accuracy, quality,
and overall provider education strategies around coding
initiatives. The Manager will work to create reports and education
materials to drive complete consistent coding, across the Innovatus
Health Network, while managing a group of professional coders.
Additional job responsibilities may include but are not limited
* Serve as a Subject Matter Expert to internal and external
stakeholders across Innovatus Health in Commercial as well as
Direct to Employer payor arrangements
* In conjunction with leadership team develop a strategy for
coding education through data and develop measureable action plans
for provider(s) not meeting targeted coding accuracy goals
* Deliver on organization and client Quality goals in a highly
matrixed work environment
* Steer centrally-administered education campaigns to result in
efficient and effective outreach efforts
* Regular meet with administrative leads in the Innovatus Health
Network to review current progress toward goals
* Maintain knowledge of current professional, regulatory, and
industry trends to consult with internal and external stakeholders
on standards and best practices.
* Support prospective partner presentations on the Quality value
proposition in conjunction with business development efforts
* Experience with payers and billing including knowledge of
ICD-10 coding guidelines
* Demonstrated track record for achieving performance
* Ability to analyze and present data
* Excellent written and oral presentation skills, with the
ability to engage, inspire, build credibility and engender trust
across all levels of an organization
* Abides and demonstrates Standards for Ethical Coding as set
forth in certifications.
* Attends workshops and brings back information appropriate to
departments impacted by professional billing/coding. Keeps abreast
of coding changes and technology.
* Demonstrate competency in use of technology and publications
for coding research, HIPAA compliance and other issues impacting
coding functions in professional billing/coding.
* Maintain certifications necessary to provide professional
billing coding support to healthcare professionals to include
maintaining or obtaining Healthcare Compliance certification if
requested by the hiring department.
Additional Experience Requirements:
* Experience working with physicians directly
* Coding experience in HCC, RAF, ACO, CIN