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.
ROLE RESPONSIBILITIES
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
SUPERVISORY RESPONSIBILITIES
- 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.
PROFESSIONAL COMPETENCIES
- 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.
WORK ENVIRONMENT
- 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 understand patient pain points, eliminating complexity while increasing transparency, for greater access and easier navigation.
We integrate and align individual incentives at all levels, from financing to optimization to delivery of care.
