Job Information
VNS Health Clinical Manager, Risk Adjustment in Manhattan, New York
OverviewAs the Clinical Manager for Risk Adjustment, you will be at the forefront of our mission to optimize clinical coding practices and enhance the efficacy of our Risk Adjustment Program. Your role involves leading initiatives to establish, develop, and maintain key operational standards, ensuring that clinical documentation and coding activities meet the highest quality standards and compliance requirements. This position can be remote.
Compensation Range:$109,900.00 - $146,500.00 Annual
What We Provide
Referral bonus opportunities
Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life Disability
Employer-matched retirement saving funds
Personal and financial wellness programs
Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
Generous tuition reimbursement for qualifying degrees
Opportunities for professional growth and career advancement
Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities
What You Will Do
Provides coding subject matter expertise and support to cross-functional initiatives and projects.
Works with management to coordinate coding compliance oversight as well as Technology/Clinical Leadership in completion of workflow enhancements, changes, and new products.
Provides updates to Risk Adjustment Stakeholders on program clinical coding and audit activities.
Reviews internal control environment to ensure responsiveness and accountability for coding compliance; identifies opportunities for improvement and leads implementation of improvements.
Identifies, corrects, and reports coding problems; makes recommendations to address ongoing problems.
Educates and collaborates with our providers in the continuous review and implementation of clinical documentation best practices.
Maintains accurate records of review activities; ensures reports and outcomes of Clinical Document Improvement (CDI) efforts are valid.
Compiles, analyzes, and summarizes data from medical records into various formats; coordinates education and feedback to providers.
Keeps abreast of changes and trends in risk adjustment coding requirements. Integrates updates into processes.
Monitors and oversees implementation of regulatory changes and serves as a resource to the Coding and Clinical Documentation staff.
Collaborates with key stakeholders to meet delivery dates and assists in the finalization of all internal and external audits.
Produces training materials and plans interactive working sessions with Coding and Audit staff members as needed.
Performs all duties inherent in a managerial role. Ensures effective staff training, evaluates staff performance, provides input for the development of the department budget, and hire, promotes, and terminates staff and recommends salary actions as appropriate.
Participates in special projects and performs other duties as assigned.
#LI-Remote
Qualifications
Licenses and Certifications:
Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or (CRC) Certified Risk Adjustment Coder in ICD-10-CM coding required
License and current registration to practice as a Registered Professional Nurse in New York State required
Education:
- Associate's degree in nursing required
Work Experience:
Minimum five years of claims coding and risk adjustment experience in a Medicare or provider organization required
Prior experience with Risk Adjustment Processing System (RAPS), Encounter Data Processing System (EDPS), EDGE Server, Risk Adjustment Data Validation (RADV) Audits and all CMS, State, and other regulatory guidelines required
Strong knowledge of EMR tools and ability to retrieve records associated with audit or review criteria required
Demonstrated understanding of Risk Score impact to plan and prioritization of data to close diagnosis gaps required
Demonstrated understanding of base of data points associated with the end-to-end process of plan payment required
Experience in gathering requirements and creating policies, procedures, and workflows to drive a successful Risk Adjustment program required
Proficient in Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and related Hierarchical Condition Coding (HCC) Methodologies required. Proficiency with Microsoft Office (Project, Word, Excel, PowerPoint, Outlook) required
Demonstrated effective leadership, communications, and coaching skills required
Demonstrated ability to establish effective working relationships with all levels in the organization required
Experience in Project Management preferred
CAREERS AT VNS Health
The future of care begins with you. Together, we will revolutionize health care in the home and community. When you join VNS Health, you become a part of something bigger. For generations, we’ve been a recognized leader and innovator in patient-centered and community-focused health care. At VNS Health, you’ll have the opportunity to meaningfully impact lives. Including yours. Discover your next role at VNS Health.