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Associate Director, Risk Adjustment Audit
Centerwell, Limited Partnership - Carson City, NV
posted 2 months ago
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.
- Ensures compliance with state and federal regulations and internal policies while analyzing coding information and medical records.
- 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, preparing quarterly audit reports.
- Collaborates with education leaders to develop a comprehensive coding education strategy.
- Cultivates relationships with divisional coding leaders and market leaders to share best practices.
- Establishes relationships with offshore coding leadership and develops quality improvement initiatives.
- Monitors auditing staff workload and develops KPIs to assess team performance.
- Fosters a positive work environment and conducts performance evaluations and career development discussions.
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 of employment)
- Bachelor's Degree in business, healthcare administration, or related field
- Well-versed in various reimbursement methodologies, including risk adjustment and Medicare
- Proficient verbal and written communication skills
- Public speaking and 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
- Bonus incentive plan
