Manager of Coding and Risk Adjustment

214bf51a-c332-4680-9417-17fe2278d7e4•Remote, AZ, US, AZ

2d•Remote

About The Position

The Manager of Coding and Risk Adjustment leads coding operations, risk adjustment initiatives, quality assurance, and provider documentation improvement. The role oversees coding staff, coding quality programs, provider education, and risk adjustment performance across multiple markets and lines of business. It serves as a subject matter expert in ICD-10 coding, CMS-HCC risk adjustment, Medicare Advantage, HEDIS, STARS, and coding compliance, and is accountable for departmental goals, coding accuracy standards, and operational performance metrics. The Manager works with executive leadership, clinical providers, quality teams, and operational leaders to improve documentation integrity, support accurate reimbursement and value-based care initiatives, and ensure regulatory compliance. The position is fully remote and includes responsibility for team leadership, operational performance, audit readiness, reporting, and process improvement.

Requirements

Five years of ICD-10 coding experience.
Three years of Medicare Advantage and risk adjustment coding experience.
Two years of leadership, mentoring, supervisory, or management experience.
Experience conducting coding audits and quality assurance reviews.
Experience providing provider education and documentation improvement support.
Strong knowledge of ICD-10-CM coding, CMS-HCC risk adjustment methodology, Medicare Advantage, Medicaid risk adjustment, HEDIS, STARS, RAF scoring, provider documentation improvement, and CMS documentation guidelines.
Knowledge of EMR platforms and healthcare technology systems.
Knowledge of claims, encounters, billing processes, and healthcare reimbursement models.
Strong analytical, organizational, and problem-solving skills.
Excellent written and verbal communication skills.
Ability to manage multiple priorities and meet deadlines in a fast-paced environment.
High school diploma or GED required.
Active Certified Risk Adjustment Coder (CRC) credential required.

Nice To Haves

Bachelor's degree in healthcare administration, health information management, business administration, nursing, or a related field preferred.
CPC, CCS, RHIT, RHIA, or an additional coding certification preferred.
Experience with Salesforce or other CRM platforms preferred.

Responsibilities

Lead, mentor, and develop Medical Risk Coders and Chart Preparation staff; conduct performance evaluations and coaching, support recruitment and onboarding, and establish performance expectations.
Oversee daily coding operations for accuracy, productivity, and compliance; review records and documentation for appropriate ICD-10-CM codes and CMS-HCC opportunities.
Monitor annual HCC recapture initiatives and identify ways to improve RAF scores and risk adjustment outcomes.
Conduct coding audits and quality reviews, maintain coding accuracy standards of at least 95%, develop corrective action plans, and support internal, external, health plan, and regulatory audits.
Monitor compliance with CMS, Medicare, Medicaid, HIPAA, and organizational policies.
Educate providers on coding accuracy, risk adjustment, HCC documentation, HEDIS, and STARS guidelines; develop training materials and reference tools and provide real-time coding and documentation support.
Review provider documentation and partner with clinical leadership to improve documentation practices and coding performance.
Develop and monitor reports on coding accuracy, audit performance, HCC recapture, provider performance, productivity, and quality outcomes; analyze trends and recommend improvements.
Assist leadership with performance goals and strategic initiatives, and implement data-driven recommendations to improve coding outcomes and financial performance.
Develop workflow improvements, support new coding processes and technology enhancements, collaborate across departments, and build scalable infrastructure and processes.
Maintain confidentiality of Protected Health Information, conduct work professionally in accordance with company policies, participate in quality improvement initiatives, and perform additional duties as assigned.