Associate Director, Risk Adjustment Audit

$102,200 - $140,700/Yr

Centerwell, Limited Partnership - Carson City, NV

Full-time - Mid Level

Remote - Carson City, NV

10,001+ employees

Real Estate

About the position

The Associate Director, Risk Adjustment is responsible for overseeing quality assurance audits of medical records and coding compliance for submissions to CMS and other payers. This role ensures accurate coding supported by clinical documentation, adheres to regulations, and leads coding education initiatives. The Associate Director collaborates across departments to enhance coding practices and documentation quality, while also managing a team of auditors and providing strategic oversight for coding-related activities.

Responsibilities

• Leads a team of coding and documentation auditors to ensure accurate coding and complete medical record documentation.
• Follows state and federal regulations while analyzing coding information and medical records.
• Ensures organizational policies align with government and payer requirements regarding coding.
• Reviews data validation and audits to identify trends and provide necessary education.
• Monitors potential coding issues and serves as a resource for other coding teams.
• Provides audit oversight for newly acquired providers and groups as needed.
• Identifies strategies for improving clinical documentation and coding practices.
• Prepares quarterly audit reports with trend analysis and action plans.
• Collaborates with education leaders to develop a coding education strategy.
• Provides coding education to teams of medical coders, both onshore and offshore.
• Cultivates relationships with divisional coding leaders and market leaders to share best practices.
• Develops continuous quality improvement initiatives for documentation and coding.
• Partners with other departments to understand their needs and develop system solutions.
• Monitors auditing staff workload and redistributes resources as needed.
• Develops KPIs to monitor audit team performance.
• Conducts performance evaluations and career development discussions with coding staff.

Requirements

• CPC, CCS, or CCS-P Certification
• 6 or more years of technical experience in Physician Office Medical Coding and/or Auditing
• 2 or more years of Management experience
• Ability to travel both locally and overnight

Nice-to-haves

• CEDO Certification
• CPMA or CRC Certifications (must obtain within the first 6 months to 1 year)
• Bachelor's Degree in business, healthcare administration, or related field
• Well-versed in various reimbursement methodologies
• Proficient verbal and written communication skills
• Public speaking / group presentation skills

Benefits

• Medical, dental and vision benefits
• 401(k) retirement savings plan
• Paid time off including company and personal holidays
• Volunteer time off
• Paid parental and caregiver leave
• Short-term and long-term disability
• Life insurance