Supervisor, Coding

AnewHealth•NJ - Remote, NJ

1d•Remote

About The Position

AnewHealth is one of the nation’s leading pharmacy care management companies that specializes in caring for people with the most complex, chronic needs—wherever they call home. We enable better outcomes for patients and the healthcare organizations who support them. Established in 2023 through the combination of ExactCare and Tabula Rasa HealthCare, we provide a suite of solutions that includes comprehensive pharmacy services; full-service pharmacy benefit management; and specialized support services for Program of All-Inclusive Care for the Elderly. With over 1,400 team members, we care for more than 100,000 people across all 50 states. This position performs technical and specialized Capstone functions. The Coding Team Supervisor oversees the coding services' organizational, developmental, and functional integrity, ensuring staff compliance, development, and education. The manager is responsible for the security and accuracy of the patient record, which requires remaining current with software and network security issues. The Coding Team Supervisor coordinates and supervises day-to-day operations within the coding team under the direct supervision of the Sr. Manager of Risk Adjustment.

Requirements

Associate’s degree or formal training beyond high school is required
Certified Coding Specialist designation (CCS) issued by the American Health Information Management Association or, Certified Professional Coder (CPC), or Registered Health Information Administrator (RHIA) or Registered Health Information Technologist (RHIT)
5+ years of professional work experience in a health plan setting.
5+ years of professional experience of risk adjustment coding experience.
Strong knowledge of Clinical Documentation Improvement.
Strong knowledge of Hierarchical Condition Categories (HCC)
Knowledge of or experience in Medicare Advantage plans
Strong experience in managed health care systems, PACE, or Medicare.
Knowledge and experience using current computer technology, and a strong knowledge of Microsoft 365 Applications; ability to easily adapt to new systems.
Excellent written and verbal communication skills, and professionalism when working with clients.
Ability to read, comprehend and analyze provider contracts.
Ability to summarize complex issues and communicate them in a way that is clearly understandable by clients.
Ability to solve problems under pressure by making immediate decisions while on the phone/in-person.
Detail oriented and able to prioritize workload.
Strong computer skills and ability to navigate spreadsheets, reports, documents and database and proprietary software.
Ability to manage multiple priorities and work independently.
Skilled in problem resolution and root cause analysis
Skilled in establishing and maintaining effective working relationships, with internal and external customers.
Ability to demonstrate resourcefulness and resolve issues in a timely manner.
Ability to work independently with minimal supervision.
Ability to communicate professionally, clearly, and effectively, verbally and in writing.
Ability to prioritize effectively.
hearing, seeing, sitting, standing, talking, and walking.
Must be able to commute to multiple site locations within assigned territory.
May be necessary to work extended hours as needed.
Applicants must be eligible to work in this country.

Nice To Haves

Bachelor’s degree in related field is preferred

Responsibilities

Manage activities of 10 or more professional medical coders to ensure compliance with departmental policies, standards, procedures, and applicable regulatory requirements.
Assist staff, as needed, to complete work and ensure all expected standards are optimally working.
Problem-solving, troubleshooting, and appropriately escalating issues to higher level management (Sr Manager of Risk Adjustment) as necessary.
Develop and coordinate educational and training programs regarding coding elements such as appropriate documentation, accurate coding, coding trends found during chart reviews, third-party audit findings, internal quality reviews, and annual coding updates.
Collaboration with other Capstone teams to provide as-needed and quarterly education to clients.
Determine efficient workflows and prioritize caseload to ensure fair work distribution.
Monitor and assess the performance of coding staff to ensure accurate code assignment and timely completion of coding tasks.
Collaborate with the Sr Manager of Risk Adjustment to deliver performance improvement and/or corrective action related to performance, attendance, and conduct.
Provides direction and mentoring of coding staff to ensure their understanding of coding principles and correct coding initiatives.
Perform clinical validation audits and interpretation of medical documentation to ensure capture of all relevant coding based on CMS Hierarchical Condition Categories (HCC) conditions that apply to Medicare Risk Adjustment reimbursement initiatives
Perform reviews for prospective and retrospective audits and RADV audits when necessary.
Provide feedback and process improvement recommendations to appropriate health plan operations departments, participate in workgroups/committee meetings, and process improvement solutions as required.
Advise Sr Manager of possible trends in inappropriate utilization and other quality issues.
Participate as requested in department meetings, client calls, and performance evaluation and management.
Provide floating coding coverage to fill in for PTO, backlogs, and irregular projects as permissible.
Reviews bulletins, newsletters, and periodicals and attends workshops to stay abreast of current issues, trends, and changes in the laws and regulations governing medical ICD-10 CM coding and documentation.
Performs other duties and responsibilities as required.
Completes miscellaneous projects for Capstone as assigned or requested.
Maintains professional license and certifications and attends training conferences/webinars as necessary to keep abreast of the latest trends in the field of expertise.
Understands and adheres to The Health Insurance Portability and Accountability Act (HIPPA) requirements.