Position Summary:
Reporting to the Director of Quality and Clinical Integration, the Risk Adjustment Program Team Lead serves as a coordinator and resource for the Risk Adjustment team; works with other coders to ensure that all coding reviews are completed in a timely manner; verifies accuracy of reports; completes own workload of coding reviews, and identifies training needs based on questions/guidance requests from the coding team. The Team Lead works closely with the Director to identify opportunities to update Risk Adjustment workflows or initiate new workflows to drive network initiatives and achieve the organization's overall goals.
Position Responsibilities:
Key Areas of Responsibility
1. Oversee the development of complex and advanced ICD-10 and Hierarchical Condition Category (HCC) coding and documentation training programs, including defining training objectives, developing training materials, and tools.
2. Implement documentation and coding training programs for network providers, presenting coding and documentation education in an appropriate format across a variety of settings.
3. Collaborate with clinical, operational, and financial leaders to optimize HCC coding and documentation workflows that support the HCC risk adjustment coding program across the organization, ensuring that coding practices align with CMS guidelines and other regulatory requirements.
4. Review documentation available in the medical record to facilitate workflows that support the clinical picture/severity of illness/complexity of the patient care rendered to patients.
5. Create train the trainer guides and standard work documents.
6. Actively participate in and maintain coding quality and productivity benchmarks.
7. Collaborate with colleagues and departments across the organization to perform retrospective and other targeted medical record reviews, ensuring documentation accuracy, evaluating clinical severity, identifying quality concerns, and supporting continuous improvement across evolving review priorities.
8. Develop and implement educational programming for providers, departments, and clinic staff relating to risk coding and documentation compliance, as well as new policies and procedures.
9. Stay up to date with changes in HCC coding regulations, ensuring organizational compliance, and implementing necessary updates to processes.
Perform other related duties as required
Working Relationships:
This Job Reports To (Job Title): Director of Quality and Clinical Integration, ICP

Qualifications:

Requirements and Specifications:
Education
 Minimum: Associate's degree in a health-related field or equivalent work experience
 Preferred: Bachelor's Degree in a health-related field or equivalent work experience
Experience
 Minimum:
o 5+ years of dedicated Risk Adjustment / HCC coding experience
o Strong knowledge of Medicare Advantage and CMS Risk Adjustment models
o Experience with:
 Pre-visit reviews
 Concurrent reviews
 Retrospective audits
 Documentation validation
 Suspect condition workflows
 Preferred:
o Strong understanding of HCC capture, recapture, RAF impact, and coding compliance principles.
o Experience working directly with providers on documentation clarification and coding education.
o Strong audit and documentation review sophistication.
o Progressively responsible role with leadership experience and previous experience working in an educational/training role preferred.
Licensure, Certification, Registration
 Minimum:
o Must possess at least one of the following certifications:
o Medical Coding Certification
o Certified Professional Coder (CPC)
o Certified Coding Specialist - Physician (CCS-P)
o Certified Coding Specialist (CCS)
 Preferred: Certified Risk Adjustment Coder (CRC) preferred
Knowledge, Skills, and Ability Requirements
 This is an on-site position.
 Requires travel to multiple practice locations.
 Reliable transportation, insurance, and a valid driver's license
 Must be able to excel in a fast-paced business environment, handling multiple priorities.
 Must be highly effective in both written and oral communication.
 Must be able to exercise appropriate judgment when making decisions.
 Commitment to maintain complete confidentiality of patient health information (PHI).
 Ability to innovate to achieve the organization's goals.
 Strong business, analytical, and project management skills; a good understanding of revenue cycle management, health care finance, and processes (including clinical workflows).
 Ability to understand and convey complex information to many different audiences is an absolute requirement, with demonstrated ability to work as a member of a team.
 Must rely on extensive experience and judgment to plan and accomplish goals.
 Must be organized and detail-oriented with a proven record of follow-up and problem resolution.
 Proven leadership skills in physician practice relationships that include influencing, efficiency, collaboration, candor, and openness with a focus on results.
 Proficient with MS Word, Excel, PowerPoint, and computer user interfaces.
 Engage with cross-functional teams and stakeholders, fostering a culture of collaboration and continuous improvement.