Supervisor of Risk Adjustment

Under the direction of the Manager of Risk Adjustment the Supervisor of Risk Adjustment oversees the Network Health/Network Health Insurance Corporation (NH/NHIC) Risk Adjustment coding efforts. The Supervisor is responsible for the development, implementation and ongoing oversight of both the internal and external risk adjustment coding programs. The Supervisor serves as the coding operational lead, coordinating with the Manager and Auditor to prioritize tasks, monitor compliance with coding guidelines and perform root cause analysis to identify issues that may contribute to coding and documentation deficiencies.

The Supervisor is responsible for the leadership and development of the Risk Adjustment coding staff, including supervision, training and performance management, consulting with Human Resources and Risk Adjustment leadership as appropriate. In addition, this position will interact with internal and external customers including administration, practitioner office staff as well as outside vendors. The Supervisor is responsible for oversight of the Risk Adjustment compliance plan coding tasks and the completeness and accuracy of Network Health's ICD-10 HCC data submitted to CMS/HHS, following mandated Federal or State coding regulations and guidelines.

Location: Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required), at our office in Brookfield or Menasha, or a combination of both in our hybrid workplace model.

Hours: 1.0 FTE, 40 hours per week, 8am-5pm Monday through Friday

Check out our 2024 Community Report to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference. Apply to this position to learn more about our team.

Job Responsibilities:

• Demonstrate commitment and behavior aligned with the philosophy, mission, values and vision of Network Health
• Appropriately apply all organizational, regulatory, and credentialing principles, procedures, requirements, regulations, and policies
• Performs day to day supervision of the internal coding staff including hiring, performance management, recognition and development. Coordinates staff schedules to ensure staffing levels meet business needs.
• Develop processes to ensure complete and accurate coding and data submission of NH/NHIC Medicare Advantage and ACA-qualified members.
• Performs audits on internal and external resources and develops Corrective Action Plans as needed.
• Assists with coordinating and performance of all CMS/HHS required audits.
• Develop standardization of audit policies, processes and guidelines.
• Manages, coordinates and evaluates the Risk Adjustment Audit and Compliance plan coding tasks.
• Development of comprehensive ICD-10 coding and documentation guidelines and initiatives, with an emphasis on chronic health conditions

Job Requirements:

• 6+ years' experience working in a coding or similar position required.
• 3+ years' experience working in HCC coding, auditing and/or risk adjustment operations required.
• 1+ years' experience in a leadership role required, preferably in the healthcare industry.
• Prior risk adjustment RADV audit experience strongly preferred.
• Certified Coder credentials required (CPC, COC, CIC, or AHIMA certification).
• Certified Risk Adjustment Coder (CRC) credentials strongly preferred.
• Thorough knowledge and understanding of CMS/HHS HCC risk adjustment models.
• Thorough knowledge and understanding ICD-10 coding guidelines and general auditing principles.
• Knowledge of medical terminology, medical disease processes and treatment patterns.

Network Health is an Equal Opportunity Employer.