Risk Adjustment Coding Manager
PacificSource

Bend, Oregon


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PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.

Position Overview: The Risk Adjustment Coding Manager will lead our risk adjustment efforts to achieve effective documentation and coding practices while improving provider relationships. The Manager will identify and maximize practice and process improvement opportunities, provider performance trends, educate providers and their practices, audit and train coding team resources and review medical charts to perform coding work. The Manager will work collaboratively with Medical Directors, EHR teams, vendor partners, and PacificSource staff to drive the overall strategy. They will oversee the daily operations and work flow of medical coding ensuring that 100% of retrieved charts are coded. Ensures certified coders accurately validate appropriate ICD-10-CM diagnosis codes when conducting medical record reviews and/or other Risk Adjustment processes, while meeting quality, accuracy, and productivity standards.

Essential Responsibilities:

  • Oversee management of Risk Adjustment Coding team and core functions pertaining Hierarchical Condition Categories (HCC) coding, medical record retrieval, provider chart audit and provider feedback.
  • Oversee management of compliance activities, internal audit activities, and provider reporting pertaining to coding accuracy across product lines.
  • Motivates team members through effective training and coaching to improve quality and professionalism on work assignments.
  • Ability to successfully perform coding quality reviews to validate correct coding.
  • Oversee management of our vendor activities as it pertains to Risk Adjustment coding.
  • Communicate with provider offices and their staffs, PacificSource Provider Network, and Risk Assessment team.
  • Provide ongoing education and feedback to physicians to obtain optimal documentation to meet coding and compliance standards.
  • Oversee management of obtaining patient records from provider Electronic Health Record (EHR) systems.
  • Oversee management of obtaining remote EHR access for our chart review vendors and internal PacificSource teams.
  • Assist the provider network department with negotiation and implementation of provider contracts.
  • Visit provider groups for on-site service calls to update office staff on administrative and claims procedures, and current coding issues.

Supporting Responsibilities:

  • Participate in provider specific and public presentations such as provider educational seminars on proper coding practices.
  • Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
  • Participate in local medical organizations such the local chapter of the American Academy of Professional Coders (AAPC).
  • Complete other projects and duties as needed and assigned.

SUCCESS PROFILE

Work Experience: Three or more years of coding management experience. At least five years HCC coding experience. Demonstrated knowledge of CMS rules regulations and current coding resources, including EM, CPT, ICD-9, ICD-10 HCPCS, fee schedule and hierarchical condition categories (HCCs). Direct experience interacting with CMS, including the RADV audit, preferred. Experience coding in a clinical setting preferred but not required.

Education, Certificates, Licenses: Bachelor's Degree or equivalent experience in related field required. CPC & CRC certification required, coding experience in IPPS and OPPS preferred.

Knowledge: Excellent analytical and problem solving abilities are required. Ability to keep current with changing technologies, work independently under limited supervision, exercise initiative within established procedural guidelines, and prioritize work to meet established deadlines a must. Ability to communicate clearly and concisely, both orally and in writing when making presentations and creating documents. The ability to establish and maintain effective work relationships, exercise good judgement, and demonstrate decisiveness and creativity. Read, understand, and interpret documents of complex subject matter.

Competencies
  • Adaptability
  • Building Customer Loyalty
  • Building Strategic Work Relationships
  • Building Trust
  • Continuous Improvement
  • Contributing to Team Success
  • Planning and Organizing
  • Work Standards

Environment: Work inside in a general office setting with ergonomically configured equipment. Travel estimated to be 10% of the time.

Our Values

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:
  • We are committed to doing the right thing.
  • We are one team working toward a common goal.
  • We are each responsible for customer service.
  • We practice open communication at all levels of the company to foster individual, team and company growth.
  • We actively participate in efforts to improve our many communities-internally and externally.
  • We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
  • We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.


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