The Risk Adjustment Coding Supervisor (Supervisor) will lead our risk adjustment efforts to achieve effective documentation and coding practices while maintaining and/or improving provider relationships. The Supervisor will identify and maximize practice and process improvement opportunities, provider performance trends, educate providers and their practices, audit and train coding team resources and review medical charts to perform coding work. They shall oversee the daily operations and work flow of the Medical Coding ensuring that 100% of the retrieved charts are coded. Provide guidance to the Medical Coders to ensure proper ICD-10 coding and CMS compliance.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

The Supervisor is responsible for the following:

• Develop practice and process to review practice documentation, coding, performance trends, and identify areas for practice improvement
• Develop tools, workflows and metrics to ensure that the accuracy and completeness of coding and documentation is improved
• Educate coders, providers and their staff on coding and documentation guidelines and updates, with emphasis on improving highly accurate and specific documentation consistent with national regulations and practice
• Perform chart reviews and decipher if they are accurate and complete in support of patient risk adjustment score accuracy
• Lead and conduct practice documentation and coding audits for RAF compliance
• Review medical records, patient medical history and physical exams, provider orders, progress notes, consultation reports, diagnostic reports, operative and pathology reports and discharge summaries in order to verify: diagnosis codes are supported by documentation according to ICD-10 CM guidelines, diagnosis codes for each chronic or major medical condition have been captured and submitted within the permitted timeframe
• Deliver effective training by preparing clear and concise tools (presentations, webinars, audit summaries, tip sheets, etc.)
• Develop professional plans and materials that support the educational and training needs of the medical practice by collaborating with internal departments

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES (Continued)

• Ascertain that documentation and coding efficiency and accuracy is improved by performing independent audits of provider and clinical records and offshore coding teams
• Coordinate activities and information exchange with health plan partners
• Ensure compliance with established protocols and procedures are maintained in the associated platforms and systems
• Ensure compliance with all applicable federal, state and/or county laws and regulations related to coding and documentation guidelines for risk adjustment
• Review medical record documentation using the Healthcare Effectiveness Data and Information Set (HEDIS) to collect and measure providers’ performance on quality of care
• Demonstrate leadership and professionalism, especially while engaging with physicians, mid-level providers and staff to help them understand the value in accurate and complete coding and documentation for their practice
• Provide guidance and motivation in their day to day job functions, actively mentoring and providing training as needed
• Ensure coding productivity and quality goals and objectives are consistently met
• Demonstrate analytical and problem-solving ability regarding barriers to improve accuracy of HCC coding; perform and/or collaborate with internal business stakeholders on analysis of trend issues, cost savings opportunities, utilization patterns, and other analysis as needed on Provider groups.
• Participate in the interview process for hiring of staff, prepare employee performance evaluations, enforce Clinicas policies and procedures to ensure compliance, assist with timesheet and time off approvals, and other personnel management related responsibilities.
• Will perform other duties as assigned, including participation in all safety programs which may include assignment to an emergency team.