Risk Adjustment Coding Director at EmblemHealth in New York, NY

Lead the development and execution of an enterprise risk adjustment coding compliance function that will identify, assess and delete submitted diagnosis codes not in compliance with CMS submission requirements. Provide oversight of chart retrieval and coding vendor to execute the compliance program. Develop and implement strategy and actionable plans to take over the coding compliance function; build the capability and coding team to assume these functions internally. Serve as the enterprise government submission compliance subject matter expert. Assist in other initiatives and projects as needed.

Responsibilities:

· Lead the development and execution of EmblemHealth’s Enterprise Risk Adjustment Coding Compliance program.

· Identify, assess and delete submitted diagnosis codes not in compliance with CMS submission requirements.

· Work with external vendors to ensure complete and accurate analysis of system codes.

· Drive the transition of coding compliance from external vendors to an in-house function.

· Identify and build an enterprise risk adjustment submission coding team to support the Risk Adjustment Coding Compliance Program.

· Develop and conduct coding education sessions with provider community to improve risk adjustment coding submissions and compliance.

· Monitor, analyze and prepare reporting of coding compliance results overall and by provider.

· Regularly meet with the provider community to share results of specific coding compliance activities.

· Ensure that appropriate corrective actions are taken to maintain compliance.

· Maintain industry coding knowledge, certifications and enterprise wide CMS coding compliance SME

· Assist in other initiatives and projects as needed.

Qualifications:

· BS in business administration or related healthcare field

· Required certifications: Risk Adjustment Coder (CRC); Professional Coder (CPC)

· Preferred certifications: Evaluation Management Coder (CEMC); Professional Medical Auditor (CPMA)

· 10+ years of related work experience in positions of increasing responsibility

· Experience with leading a compliance related function across a large division, department, or company

· Self-starter with ability to work with multiple levels of management and handle multiple tasks successfully

· Prior experience working with external vendors

· Proven track record of collaboration and coordination across all levels of provider organizations

· Proven track record of collaboration and coordination across an entire enterprise or large division

· Effective communications skills (verbal and written) with all types and levels of audiences.

· Proficiency with MS Office applications (word processing, spreadsheet/database, presentation)

· Energetic and enthusiastic with a positive attitude

· Knowledge of healthcare operational processes and products

Additional Information

• Requisition ID: 200YG