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Risk Adjustment Supervisor

Risk Adjustment Supervisor

Millennium Physician GroupFort Myers, FL, US
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Job Description

Job Description

Summary

The Supervisor of Risk Adjustment (RA) Auditing and Coding reports to the Risk Adjustment

Manager. S / he performs duties to conduct the day-to-day operations of the Risk team functions

by communicating with other operational departments and Provider Offices. S / he will

participate in the development, implementation and performance of workflows for auditing

electronic medical records aimed at improving the health and well-being of patients and proper

identification of Chronic Disease Conditions as well as working to create a unique data and

reporting model to capture and optimize ICD10 reporting to Payers to improve quality for our

patients and reduce healthcare costs for our clients.

Essential Duties and Responsibilities i nclude the following. Other duties may be assigned.

  • Ensure compliance with all applicable Federal, State and / or County laws and regulations

related to coding and documentation guidelines for Risk Adjustment.

  • Review medical records, patient medical history and physical exams, physician orders,

    • progress notes, consultation reports, diagnostic reports, operative and pathology reports,

    and discharge summaries in order to verify whether :

  • The diagnosis codes are supported by the documentation and ensure with ICD-10-CM

    • Guidelines for Coding and Reporting.

  • The diagnosis codes for each chronic or major medical condition have been captured and

    • submitted within the permitted timeframe.

  • Any diagnosis code identified as being unsubstantiated by the record must be submitted

    • to the carrier within timely guidelines to ensure on supported codes remain on record

    with those carriers.

  • Review for clinical indicators and query providers to capture the severity of illness of the

    • patient.

  • Measure Providers' performance on important aspects of care and service.
  • Ensure the highest level of customer satisfaction possible.
  • Communicates and coordinates reviews with Quality Programs Educator and Support

    • Services for use in provider / staff training sessions.

  • Facilitates and coordinates reporting to leadership within the organization as requested
  • Provides clear, concise and professional communication to varying audiences depending

    • on the project and its goals.

    Human Resources Job Description : (Risk Adjustment Supervisor) Rev. 2 / 11 / 2021

  • Supports the RA Team in a positive manner with emphasis on providing excellent service

    • to all patients, providers, internal and external customers.

  • Communicates to supervisor and IT Department regarding defects identified in the

    • reporting systems or data base, suggests performance improvement opportunities and

    tracks through completion to insure revenue capture.

  • Demonstrates excellent time management, attends and contributes to required meetings

    • which may include travel as well as hours outside of standard business hours and / or

    above 40 hours per week.

  • Demonstrates the ability to train new staff or provide ongoing education and training to

    • existing staff along with regularly performing quality reviews and including feedback on

    opportunities for improvement to the Risk Coding team.

  • Leads and empowers risk team through coaching, rounding, goal setting and monitoring.

    • Supervisory Responsibilities

    Directly supervises assigned employees in the Risk department. Carries out supervisory

    responsibilities in accordance with the organization's policies and applicable laws.

    Responsibilities include interviewing, hiring, and training employees; planning, assigning, and

    directing work; appraising performance; rewarding and disciplining employees; addressing

    complaints and resolving problems.

    Education and / or Experience

    Bachelor's degree from four-year college or university; or two - three years related experience

    and / or training; or equivalent combination of education and experience. Must have one of the

    following : CPC, CRC, RHIT or similar. Position requires flexibility in work hours, multitasking, and excellent computer skills.

    Job Posted by ApplicantPro

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    Risk Adjustment • Fort Myers, FL, US