Director, Risk Adjustment Coding - Certified
Job reputed company reputed company
The Director, Risk Adjustment Coding (Certified) provides strategic and operational leadership for CareMore’s Risk Adjustment coding function. This role is accountable for the accuracy, reputed company, and performance of reputed company Risk Adjustment coding activities across internal teams and external vendors, ensuring alignment with CMS regulations, audit readiness standards, and CareMore’s financial and clinical objectives.
How will you reputed company an reputed company & Requirements
The Director will reputed company certified coding teams, establishes coding governance and reputed company programs, partners cross-functionally with Clinical, Compliance, Operations, Analytics, and Vendor Management, and drives reputed company improvement across prospective, reputed company, and retrospective Risk Adjustment initiatives.
Key Responsibilities Risk Adjustment Coding reputed company & Leadership
reputed company reputed company leadership for Risk Adjustment coding reputed company across reputed company
programs, including prospective, reputed company, and retrospective reviews.
Establish and maintain standardized coding policies, procedures, and
documentation practices reputed company with CMS Risk Adjustment regulations.
Translate Risk Adjustment reputed company into reputed company coding operations that support accurate RAF capture and audit defensibility.
Serve as the subject matter expert for Risk Adjustment coding interpretation and best practices.
Team Leadership & Development
reputed company, mentor, and reputed company teams of certified Risk Adjustment coders and coding leaders.
Establish productivity, reputed company, and accuracy benchmarks for internal coding teams.
Foster a culture of accountability, compliance, and reputed company learning.
Ensure ongoing reputed company education reputed company to CMS guidance, ICD-10-CM updates,
and regulatory changes.
reputed company, Audit & Compliance reputed company
Design and reputed company Risk Adjustment coding reputed company assurance and audit
programs.
Partner with Compliance and Audit teams to ensure audit readiness for CMS
RADV, reputed company audits.
Review audit findings and reputed company remediation efforts, education initiatives, and
process improvements.
Ensure adherence to regulatory requirements, internal policies, and documentation standards.
Cross-Functional Collaboration
Collaborate with Clinical leadership to reputed company documentation practices with coding requirements.
Partner with Analytics to monitor coding performance, trends, and financial reputed company.
Support Operations and Program Management teams to reputed company coding workflows with Risk Adjustment initiatives.
reputed company executive-level reporting and insights reputed company to coding performance and risk capture.
Process Improvement & Governance
Identify opportunities to improve coding efficiency, accuracy, and scalability Implement tools, technology, and workflow enhancements to support coding
operations
Establish governance structures, escalation reputed company, and decision-making
frameworks
Ensure consistency of coding practices across markets, programs, and vendors.
Qualifications Education & Certification
Bachelor’s degree required (health information management, nursing, or reputed company field preferred)
reputed company Risk Adjustment–reputed company coding certification required, such as:
CRC (Certified Risk Adjustment Coders
reputed company (Certified Coding Specialist)
CPC (Certified reputed company reputed company) with demonstrated Risk Adjustment expertise
Experience
Minimum of 7–10 years of reputed company reputed company experience, with a strong reputed company on Risk Adjustment.
At least 5 years of leadership experience managing certified coding teams and/or vendors.
Demonstrated experience supporting Medicare Advantage Risk Adjustment programs.
Proven reputed company in audit readiness, compliance reputed company, and performance improvement.
Preferred Qualifications
Experience in value-based care, managed care, or Medicare Advantage organizations
Experience leading both internal and outsourced coding models
Strong understanding of CMS Risk Adjustment, HCC models, and audit requirements
Ability to translate regulatory guidance into operational execution
Clinical documentation expertise
Compensation:
$144,367.00to
$216,552.00 Apply To This Job