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About the role
- Risk Adjustment Coding Supervisor overseeing coding operations and compliance at Astrana Health. Mentoring staff and driving data-driven improvements for quality care and CMS guidelines compliance.
Responsibilities
- Supervise, coach, and mentor Risk Adjustment Coding Specialists to ensure high-quality, compliant coding practices.
- Serve as a resource for coders regarding ICD-10-CM, HCCs, CMS Risk Adjustment guidelines, and documentation standards.
- Monitor individual and team productivity, accuracy, and quality metrics; provide ongoing feedback and corrective action as needed.
- Utilize productivity, quality, and audit data to identify performance trends, coding gaps, and training opportunities.
- Translate data insights into actionable feedback, performance improvement plans, and targeted education.
- Assist with onboarding and training of new coding staff.
- Support the Risk Adjustment Manager with day-to-day departmental operations, workflow coordination, prioritization of audits, and issue resolution.
- Assist in developing and maintaining standard operating procedures, workflows, and best practices.
- Analyze Risk Adjustment data (e.g., recapture rates, audit findings, productivity, denial trends) to support departmental strategy and prioritization.
- Collaborate with leadership to design and implement new or enhanced workflows for coders based on data, performance metrics, and operational needs.
- Support reporting and dashboard development to track coding performance, quality outcomes, and Risk Adjustment impact.
- Escalate operational, compliance, or performance issues to leadership as appropriate.
- Review provider documentation and medical records to ensure all Medicare Advantage and Commercial Risk Adjustment requirements are met.
- Perform and/or oversee retrospective and prospective medical record reviews to identify, assess, monitor, and document HCC coding opportunities.
- Conduct coding quality audits to ensure ICD-10-CM codes are accurately assigned and supported by clinical documentation.
- Analyze audit results to identify systemic coding or documentation trends and recommend process improvements.
- Prepare audit analyses and provide feedback on noncompliance or documentation improvement opportunities.
- Interact with physicians and provider office staff regarding coding, billing, and documentation policies and procedures.
- Deliver education and training on Risk Adjustment and documentation improvement, both individually and in group settings.
- Assist with the development of educational materials and presentations, including PowerPoint content.
Requirements
- Minimum of 4–5 years of medical coding experience, including Risk Adjustment and HCC coding.
- Prior lead, senior, or supervisory experience.
- Strong knowledge of Medicare Advantage Risk Adjustment and Hierarchical Condition Categories (HCC).
- Strong data analysis skills with the ability to interpret coding, audit, and performance metrics.
- Ability to identify patterns and trends within Risk Adjustment data to inform decision-making and workflow design.
- Experience using data to drive operational improvements and support Risk Adjustment initiatives.
- Advanced Excel skills preferred (e.g., pivot tables, reporting, data analysis).
- Excellent verbal, written, and presentation skills.
- Demonstrated ability to educate and train coding staff and provider office personnel.
- Expert-level proficiency in Microsoft Word, Excel, Outlook, and PowerPoint.
- Strong organizational, analytical, and problem-solving skills.
Benefits
- Our organization follows a hybrid work structure where the expectation is to work both onsite and at home on a weekly basis. Up to 75% travel is required in designated market(s).
- The total compensation target pay range for this role is $80,000 - $90,000 per year.
- Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer.
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