Manager, Coding Operations

Strive Health•Quinte West, ON

2d•$85,500 - $104,000•Hybrid

About The Position

At Strive Health, patients come first. We’re on a mission to transform chronic conditions by identifying risk earlier, coordinating thoughtful care, and supporting people through every stage of their health journey. Our work reduces emergency visits, improves outcomes, and helps patients live fuller lives. You’ll work alongside passionate Strivers who care deeply about making an impact, show up for one another as One Team, and find ways to elevate the everyday. If you’re looking for meaningful work where your contributions truly matter, you’ll feel right at home at Strive!

Requirements

Bachelor’s Degree in related field or an equivalent combination of education and experience.
Medical Coding Certification, Certified Professional Coder(CPC) or Certified Risk Adjustment Coder (CRC) preferred.
Experience in managing remote production based teams.
5+ years related experience in health care and managed care settings.
5+ years experience in medical record review, healthcare payment and coding methodologies, (i.e. ICD 10-CM, CPT, HCPCS, DRG, HCC coding and RADV audits).
Extensive knowledge of documentation and coding guidelines established by the Center for Medicare and Medicaid Services (CMS) and the American Medical Association (AMA) for assignment of diagnostic and procedural codes.
Experience with different MA, ESRD, and ACA HCC Models.
Knowledge of Federal laws and regulations, including NCDs and LCDs affecting risk adjustment documentation and coding compliance.
MS Office Suite, Electronic Medical Records, Encoder, and other software programs and internet-based applications.
2+ years managing high performing coding production teams.
Internet Connectivity - Min Speeds: 3.8Mbps/3.0Mbps (up/down): Latency <60 ms.
Ability to travel and be onsite to meet business needs.

Nice To Haves

The motivation and drive to work independently with minimal supervision to pursue continuous development of self and others are required.
In-depth experience in Medicare Risk Adjustment processes and impacts.
Retrospective vendor chart review.
Expert in coding and documentation guidelines, knows how to develop strong relationships with clinicians.
Strong ability to work collaboratively and cross-functionally in a fast-paced, often changing environment.
Understanding of Value Based Care.
Excellent verbal and written communication skills.
Excellent interpersonal communication skills.

Responsibilities

Oversee coding department functions and manages day to day operations; coding, turn-around times, accuracy, queries/communications, denial issues, error trends, and provide clinician education support.
Manages and trains/orients assigned personnel. Evaluates coder performance and disciplinary actions, provides developmental coaching, reviews and submits timesheets.
Monitors productivity and performs monthly QA audits of coders for 95% accuracy adherence and adequacy of proper diagnosis, procedure and modifier assignment. Develops corrective action plans, including education as necessary.
Reports on all coding KPI’s to Director of Risk Adjustment Coding Operations.
Develops and maintains coding department workflows, policies and procedures.
Establishes workload assignments and necessary adjustments for assigned team members.
Assists in monthly ASM abstraction and submission.
Works closely with Director of Risk Adjustment Coding operations and coding leads to identify HCC and ProFee coding trends or issues for providers and team members.
Provides additional oversight of Risk and ProFee coding processes and procedures to assure proper application of ICD-10 CM, CPT and CPT II/HCPCS coding and compliance policies.
Develop and implement coding education and training for team members and providers as necessary.
Serves as the source for coding escalation questions and resolutions.
Assist with conducting internal physician chart audits for reimbursement utilization (includes research and presentation).
Works and communicates with various departments within the organization related to HCC and procedural coding and compliance, including billing, finance, analytics, compliance, risk and HEDIS enablement, and network provider team members.
Responsible for maintaining current knowledge of coding guidelines and relevant federal regulations through use of current CPT, HCPCS II and ICD-10CM materials, the Federal Register and other pertinent materials.