Risk Score Accuracy (RSA) Program Manager - Population Health

Bon Secours Mercy Health

81d

About The Position

The Risk Score Accuracy (RSA) Program Manager provides leadership, oversight, coordination, and subject matter expertise for insights related to Population Health Clinical Integration RSA initiatives, including Hierarchical Condition Categories (HCC) coding and other risk adjustment payment models. This role strategizes and collaborates with key stakeholders across the Ministry, including Bon Secours Mercy Health (BSMH) Population Health, Compliance and Revenue Cycle teams, Ensemble, and BSMH physicians and advance care clinicians, to achieve system-wide success in value-based contracts. This is a remote/work from home position. Hire must be open to working eastern time zone hours.

Requirements

• Certified Professional Coder (CPC) or equivalent, preferred at time of hire, required within one year of hire.
• Certified Risk Coder (or equivalent), Licensed Practical Nurse or other clinical certification (preferred).
• Bachelor’s Degree (preferred).
• 5 years of experience progressive responsibility, with risk score accuracy or quality outcomes experience, with a payer or in a healthcare system (required).
• Epic Electronic Health Record (preferred).

Responsibilities

• Oversees prospective, concurrent, and retrospective chart reviews for diagnosis coding accuracy leading to value-based contract success through compliant coding and documentation.
• Supports payer relationships by coordinating chronic condition recapture and suspect condition validation processes and recording HCC suspect validation responses in payer portals.
• Collaborates with plan representatives to obtain and analyze RSA gap data.
• Tracks payer-specific RSA performance to share with providers and leadership.
• Facilitates responses to payer-focused HCC validation requests and communicates missed HCC trends to System Director of RSA for dissemination to clinical leadership.
• Monitors payer suspect algorithms for potential internal HCC build improvements.
• Partners with BSMH Compliance to deliver accurate HCC coding instruction as part of ambulatory provider training and onboarding, ensuring compliance with federal and state coding regulations.
• Identifies opportunities for performance improvement related to system-wide HCC and other risk adjustment coding initiatives.
• Conducts medical record reviews and analyzes internal data to identify opportunities for real-time training intervention related to ICD-10-CM coding and risk adjustment scores.
• Coordinates and participates in collaborative coding forums with BSMH coders and Revenue Cycle team, BSMH Compliance and Internal Audit teams, Ensemble coding and billing leaders, BSMH leaders, and Population Health team to share best practices and optimize resources.
• Communicates provider coding accuracy concerns and challenges to System and Local Market leadership, delivers or participates in education sessions, and attends coding leadership meetings as requested.
• Develops HCC and ICD-10-CM coding tools and references.
• Monitors trends for patient populations in value-based contracts and provides feedback to providers and appropriate Ministry leadership to ensure diagnosis coding accuracy and supportive documentation for reduction in compliance risks and costs, as well as appropriate reimbursement based on complexity of patient care.
• Maintains knowledge of professional coding certification requirements and promotes recruitment and retention of certified staff in coding positions within the health system.

Benefits

• Competitive pay, incentives, referral bonuses and 403(b) with employer contributions (when eligible).
• Medical, dental, vision, prescription coverage, HSA/FSA options, life insurances, mental health resources and discounts.
• Paid time off, parental and FMLA leave, shot- and long-term disability, backup care for children and elders.
• Tuition assistance, professional development and continuing education support.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Bachelor's degree