Manager, Coding and Risk Adjustment

Job not on LinkedIn

🕒 6 days ago

🌵 Arizona – Remote

🌵 Arizona – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🎲 Risk

👻 Ghost score 12%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Adobe Population Health

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Adobe Population Health is a care management company that provides integrated population health and whole-person care management solutions for public and commercial health plans. The organization partners with Medicaid, Medicare, and ACA Marketplace plans to deliver proactive case management, in‑home support, and technology-enabled services (including an app that identifies social determinants of health barriers and connects members to local resources). Adobe Population Health also expands clinical offerings through acquisitions (e. g. , Eventa for respiratory care) and reports outcomes such as reduced ER use, lower claim costs, and high HRA completion rates.

📋 Description

• Lead, mentor, and develop a team of Medical Risk Coders and Chart Preparation staff • Conduct performance evaluations, coaching sessions, and ongoing staff development activities • Assist with recruitment, onboarding, training, and retention of coding team members • Establish productivity, quality, and performance expectations for coding staff • Oversee daily coding operations for accuracy, productivity, and compliance • Review medical records and documentation to identify appropriate ICD-10-CM diagnosis codes and CMS-HCC opportunities • Monitor HCC recapture initiatives and improve RAF scores and risk adjustment outcomes • Maintain departmental coding accuracy standards of 95% or greater • Conduct coding audits and quality reviews; develop corrective action plans • Monitor compliance with CMS, Medicare, Medicaid, HIPAA, and organizational policies • Support internal, external, health plan, and regulatory audit readiness • Educate and train providers on coding accuracy, risk adjustment, HCC documentation, HEDIS, and STARS guidelines • Review provider documentation and develop training materials and coding reference tools • Partner with clinical leadership to improve provider documentation and coding performance • Provide real-time coding and documentation support to providers and clinical teams • Develop and monitor reports on coding accuracy, audit performance, HCC recapture, provider performance, productivity, and quality outcomes • Analyze coding trends and implement data-driven operational and financial improvements • Develop workflow improvements and support new coding processes, technologies, and system enhancements • Collaborate with cross-functional departments and drive scalable infrastructure improvements • Maintain confidentiality of Protected Health Information (PHI) • Participate in quality improvement initiatives and perform additional duties as assigned

🎯 Requirements

• Five (5) years of ICD-10 coding experience • Three (3) years of Medicare Advantage and Risk Adjustment coding experience • Two (2) 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 • Strong knowledge of CMS-HCC Risk Adjustment Methodology • Strong knowledge of Medicare Advantage • Strong knowledge of Medicaid Risk Adjustment • Strong knowledge of HEDIS • Strong knowledge of STARS • Strong knowledge of RAF Scoring • Strong knowledge of Provider Documentation Improvement (PDI) • Strong knowledge of 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 • Bachelor's degree in healthcare administration, health information management, business administration, nursing, or a related field preferred • CPC, CCS, RHIT, RHIA, or additional coding certification preferred • Experience with Salesforce or other CRM platforms preferred • Must be able to physically perform the essential duties, including lifting 30 lbs., transporting materials, stooping, kneeling, crouching, reaching, use of hands, balancing, walking, standing, talking, hearing, and typing

🏖️ Benefits

• Paid Orientation and Training • Medical, Dental, Vision, and Life insurance • 401k Plan – 3% match • Employee Assistance Program • Tuition Reimbursement • Continued Education Support • Mileage Reimbursement (if applicable) • Referral Bonuses • Paid Holidays (9 days) • Paid Time Off (20 days) • Paid Volunteer Hours • Fully remote position

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