Risk Adjustment Coding Coordinator

Mass General Brigham•Somerville, MA

19d•$78,000 - $113,454•Remote

About The Position

Risk Adjustment Coding Coordinator Site: Mass General Brigham Health Plan Holding Company, Inc. Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham. Job Summary The Risk Adjustment Coder works to improve the coding and quality aspects of risk adjustment processes. In partnership with key stakeholders, supports management of oversight of vendors and continuously works to improve people, processes, and technology across the function. The position works to manage accurate and compliant coding practices, find opportunities for documentation improvement, optimize risk adjustment processes, and support revenue cycle management.

Requirements

Bachelor's Degree preferred
Certified Risk Adjustment Coder (CRC)® certification
At least 1-2 years of experience in medical coding or risk adjustment coding required
In-depth knowledge of ICD-10, CPT, and HCPCS coding systems, particularly as they relate to risk adjustment.
Strong analytical abilities to assess coding accuracy and identify areas for improvement.
Excellent verbal and written communication skills for effective training and collaboration with clinical staff and coding teams.
High level of accuracy and attention to detail in coding and documentation processes.
Familiarity with healthcare regulations and guidelines related to risk adjustment and coding compliance.

Responsibilities

Actively contributes to the strategic direction for Risk Coding and collaborates with vendor partners to lead volume and ensure adherence to agreed upon SLAs.
Establishes KPIs for risk coding functions; ensures the implementation of action plans when performance does not meet expectations.
Communicates relevant changes in performance, market trends, healthcare delivery systems, and legislative initiatives impacting the execution of team goals to team(s).
Provides direction and oversight across the organization's Risk Coding methodology, performance, and workflows.
Monitors, implements, and contributes to financial planning provided by leadership to support a cost-effective Risk Coding strategy.
Leads the offshore volume for risk coding and ensures vendors are held to agreed-upon SLAs.
Develop and implement quality improvement initiatives; examples include conducting regular audits, educating coders/clinicians, and monitoring KPIs for improvements.
Conduct training and education sessions for healthcare providers and coding staff on risk adjustment coding requirements and best practices.
Performs other duties as assigned
Complies with all policies and standards