Senior Manager, Risk Adjustment Operations

The Opportunity

We are seeking a human-centered leader to join our growing risk based coding operations team. The Manager will play a critical role, working closely with clinical operations and revenue cycle teams to deliver an uncompromising patient experience in an innovative practice model. One Medical has a network of primary care practices where we take the time to know our patients as true individuals, and proactively provide the care, support, and inspiration they need to live their best life. We are a fast-paced, fresh-thinking, high-growth company building a better model of health care delivery.

What you'll likely work on:

• Create and lead initiatives that support coding and documentation quality
• Implement process improvement that supports risk adjustment coding
• Work with market leaders to understand their unique challenges then develop actionable work plans to implement resolutions
• Work with analytics, clinical operations, and performance consultants to understand performance at a National, Market, physician practice, and provider level to identify opportunities for improvement
• Assist in collaborating with cross functional teams to develop and execute communication plans impacting risk adjustment program operations
• Act as the internal subject matter expert and escalation point for risk adjustment capabilities for market teams and providers Utilize data analysis for developing ideas, programs and projects
• Manage a team of in-market risk adjustment educators conducting activities geared towards improving healthcare outcomes
• Ensure HCC Concurrent Coding and Training programs are operating effectively and efficiently
• Develop and maintain compliant, centralized training materials, such as webinars, recorded trainings, to support providers and their staff in coding and documentation
• Implement risk adjustment programs in new markets and offices as needed
• Review and sign-off on all coding updates
• Work effectively with clinical operations to support coding quality initiatives
• Support Clinical leadership with risk adjustment audits
• Accurately follow documentation and coding guidelines and legal requirements to ensure compliance with federal and state regulatory bodies
• Assist with risk adjustment vendor oversight

What you’ll need:

• Certified Risk Adjustment Coder (CRC) required
• Minimum of 7+ years' experience coding ICD-10-CM; Previous experience with Risk Adjustment training 
• Minimum of 1 year of management experience, experience managing Revenue Cycle vendor relationships preferred
• Expert knowledge of Federal laws and regulations, including NCDs and LCDs affecting risk adjustment documentation and coding compliance
• Extensive knowledge of documentation and coding guidelines established by the Center for Medicare and Medicaid Services (CMS) and the American Medical Association (AMA) for assignment of diagnostic and procedural codes
• Knowledge of Health care insurance claims practice and compliance
• Compliance with all HIPAA regulations

Benefits designed to aid your health and wellness:

Taking care of you today

• Paid sabbatical after 5 and 10 years
• Employee Assistance Program - Free confidential advice for team members who need help with stress, anxiety, financial planning, and legal issues
• Competitive Medical, Dental and Vision plans
• Free One Medical memberships for yourself, your friends and family
• Pre-Tax commuter benefits
• PTO cash outs - Option to cash out up to 40 accrued hours per year

Protecting your future for you and your family

• 401K match
• Opportunity to participate in company equity programs
• Credit towards emergency childcare
• Company paid maternity and paternity leave
• Paid Life Insurance - One Medical pays 100% of the cost of Basic Life Insurance
• Disability insurance - One Medical pays 100% of the cost of Short Term and Long Term Disability Insurance

This is a full-time role based anywhere in the US

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