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Supervisor, Risk Adjustment Coding

Company: SilverSummit Healthplan
Location: Gardnerville
Posted on: June 4, 2024

Job Description:

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility.
Supervise the daily operations and work flow of the Medical Coding Specialists ensuring that 100% of the retrieved charts are coded. Provide guidance to the RAPS Medical Coding specialists to ensure proper ICD-9 coding and CMS compliance. Candidate Education: Required A Bachelor's Degree in a related field. Candidate Experience: Required 5+ years of experience in professional coding either in a hospital or physician setting.
Required 3+ years of experience in managed care with knowledge of RAPS.

  • The Supervisor, Medical Coding Specialists (S-MCS) supervises the daily operations and work flow of the Medical Coding Specialist (MCS) Team;
  • The S-MCS provides guidance and motivation to the MCS Team in their day to day job functions, actively mentoring and providing training as needed;
  • He/she ensures coding productivity and quality goals and objectives are consistently met;
  • The S-MCS provides ongoing training and continuing education to the Medical Coding Specialists regarding risk adjustment, proper ICD-9 coding, and ICD-10 coding through written materials, conference calls, Webinars, or presentations;
  • He/she serves on the RADV committee as a subject matter expert;
  • The S-MCS coordinates yearly continuing education unit (CEU) coder training seminars;
  • He/she conducts staff meetings on a weekly basis - instilling a team approach, focused on meeting productivity goals and compliance metrics;
  • The S-MCS works closely with the Mgr, Medical Coder Auditing to ensure that the MCS Team's coding is meeting and/or exceeding QA standards. Upon approval of the Director, Risk Adjustment, the S-MCS and the M-MCA will develop, implement, evaluate and improve coding policies and procedures and departmental operations as needed;
  • He/she serves as the MCA business representative for system enhancements (e.g. data entry tool design);
  • The S-MCS is accountable for understanding the intricacies of the ICD-9 coding guidelines and its application to risk adjustment coding;
  • An important function of the S-MCS is to prepare and submit to the Director, Risk Adjustment weekly productivity reports including key performance metrics and quarterly productivity trending reports. The S-MCS is responsible for researching industry best practices for productivity-enhancement processes, for understanding the financial impact of productivity, data capture and reporting tools, processes and systems to present to the Director, Risk Adjustment on a quarterly basis;
  • The S-MCS and the M-MCA develop mutually agreed upon corrective action plans, training sessions, and re-training programs to ensure that the QA standards are consistently met;
  • He/she ensures compliance with all applicable federal, state and local regulations, as well as with institutional/organizational standards, practices, policies and procedures;
  • The S-MCS assists in other projects as necessary.
  • The S-MCS reviews members' medical records from primary and specialist care providers to identify all ICD-9's that meet CMS and ICD-9 coding guidelines. Complete data entry for identified ICD-9's
  • The S-MCS is responsible for hiring, promoting, establishing PIP, establishing goals and objectives, conducting performance appraisals, approving time, and establishing P&P for the MCS. Additional Responsibilities:Preferred Other 3+ years supervisory experience Licenses and Certifications: A license in one of the following is required: Required Certified Professional Coder (CPC)Pay Range: $67,400.00 - $121,300.00 per yearCentene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Keywords: SilverSummit Healthplan, Carson City , Supervisor, Risk Adjustment Coding, Other , Gardnerville, Nevada

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