Manager, Coding Audits and Compliance

Mass General Brigham•Somerville, MA

3d•$99,466 - $141,804•Remote

About The Position

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are at the forefront of transformation with one of the world’s leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage. Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills. We are pleased to offer competitive salaries and a benefits package with flexible work options, career growth opportunities, and much more. Oversees the coding audit and compliance aspects of risk adjustment processes. In partnership with key stakeholders, the role supports the management of oversight of offshore vendors and continuously works to improve people, processes, and technology across the function. The Risk Coding Audit team works to manage accurate and compliant coding practices, find opportunities for documentation improvement, optimize risk adjustment processes, and support revenue cycle management. The position applies knowledge of key business drivers and the factors that improve the Risk Adjustment departmental performance and anticipates business and regulatory issues and trends to identify improvements.

Requirements

Bachelor's Degree ( Health Information Management, Nursing, or another related field of study) required; experience can be considered in lieu of a degree
Certified Risk Adjustment Coder (CRC) - Required within 6 months of start date
At least 5-7 years of experience in medical coding, risk coding, or RADV audits required
At least 1-2 years of experience in a management or supervisory role required
In-depth knowledge of coding standards, including ICD-10, CPT, and HCPCS.
Strong leadership and team management skills.
Excellent attention to detail and analytical skills.
Proficiency in coding software and electronic health records (EHR) systems.
Effective communication skills, both written and verbal.
Ability to work collaboratively across departments to achieve organizational goals.
Strong problem-solving abilities and the capacity to manage risk.
Commitment to continuous learning and staying informed on coding regulations.

Nice To Haves

Certified Professional Coder (CPC) - Preferred
Certified Coding Specialist (CCS) - Preferred

Responsibilities

Oversee daily risk coding audit operations to ensure compliance with regulations and standards.
Provide leadership and guidance to the coding audit team, ensuring proper training and adherence to coding guidelines.
Establishes KPIs for risk coding functions; ensures the implementation of action plans when performance does not meet expectations.
Conduct audits and reviews of coding practices to identify and address discrepancies.
Lead end-to-end RADV efforts, coordinating cross-functional teams, managing audit preparation and submissions, and ensuring timely and compliant responses to CMS and external auditors.
Implement and monitor risk mitigation strategies related to coding practices.
Provides direction and oversight across MGB’s Risk Coding methodology, performance, and workflows.
Stay updated on changes in coding regulations and communicate these changes to the team.
Develop and enforce policies and procedures to maintain coding accuracy and integrity.
Prepare and present reports on coding performance and risk areas to senior management.
Oversee vendor management and proper compliance with internal and external required procedures