Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes.
What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be Collaborative.
If you share our passion for changing healthcare so all people can live healthy, brighter lives – apply to join our team.
SCOPE OF ROLE
The NeueHealth Risk Adjustment Team is an integral component of Bright Health Group’s success as it defines and ensures outstanding clinical care for our members. As a Manager, Risk Adjustment Coding Quality, you will be responsible for the oversight of coding accuracy for internal stakeholders while assisting with the expansion of the NeueHealth innovative Risk Adjustment Program. This role will serve as the primary for managing contract coders and projects as required. The manager of risk adjustment coding quality will work with the other area managers to ensure coding accuracy. This role works across departments, teams, project development offices, and lines of business to deliver best-in-class business results under strict regulatory adherence and compliance mindset.
The Manager, Risk Adjustment Coding Quality responsibilities include, but it is not limited to these items.
Manage all aspects of coding quality for internal risk adjustment coding reviews of Bright Health Group affiliates
Manage team and projects for external contract coders as needed
Serve as Subject Matter Expert (SME) for all aspects of Risk Adjustment across all lines of business
Assist in ensuring there are adequate resources for all the risk adjustment initiatives and activity throughout the year
Quality oversight of internal risk adjustment coding team’s work to ensure 95% coding quality accuracy
Collaborate with the other leaders of Risk Adjustment on provider education initiatives
Advise leadership team on coding changes, regulations, and submission updates
Maintain all coding certifications and requirements and keep up to date on knowledge of Risk Coding guidelines, submissions and audits
Annually, or as indicated, update coding quality policies and procedures
This position does have supervisory responsibilities for members of the Risk Adjustment team.
EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
Current AAPC or AHIMA certification.
Bachelor’s degree preferably in healthcare or technical related field or equivalent work experience required
Three (3) or more years’ experience in Medicare Advantage, Commercial ACA, or related healthcare coding and risk adjustment is required; two (2) or more years in risk adjustment management is preferred.
Five (5) or more years of coding experience is required.
Proven ability to lead risk adjustment and coding measurement, evaluation, execution, and monitoring
Demonstrated knowledge of Medicare and Marketplace risk adjustment regulations
Analytical background and mindset
Able to use data to draw insights and present data to internal team and care partners
LICENSURES AND CERTIFICATIONS
An active, and unrestricted Certified Risk Adjustment Coder (CRC) Certification is required.
The majority of work responsibilities are performed remotely, carrying out detailed work sitting at a desk/table and working on the computer.
Travel may be required.
We’re Making Healthcare Right. Together.
We are realizing a completely different healthcare experience where payors, providers, doctors, and patients can all feel connected, aligned and unified on the same team. By eradicating the frictions of competing needs, we are making it possible to give everyone more of what they want and deserve. We do this by:
Focusing on Consumers We understand patient pain points, eliminating complexity while increasing transparency, for greater access and easier navigation.
Building on Alignment We integrate and align individual incentives at all levels, from financing to optimization to delivery of care.
Powered by Technology
We employ our purpose built, integrated data platform to connect clinical, financial, and social data, to deliver exceptional outcomes.
As an Equal Opportunity Employer, we welcome and employ a diverse employee group committed to meeting the needs of Bright Health, our consumers, and the communities we serve. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.