Manager, Risk Adjustment Coding Support

Manager, Coding Support Specialist

Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones. Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business. Join Evolent for the mission. Stay for the culture.

What You Will Be Doing

Evolent Care Partners is seeking a Risk Adjustment Coding Support Manager to be a core member of the Risk Adjustment Coding Support team. Evolent Care Partners' mission is to partner directly with primary care organizations across the country to improve patient outcomes and reduce avoidable healthcare costs. We are a lean, nimble, fast-paced team looking for dedicated team members with a passion for improving healthcare.

Our Risk Adjustment coding support team offers candidates the opportunity to make a meaningful impact by providing support to our providers, practices, and peers. The team values collaboration, continuous learning, and a patient-centric approach, ensuring every team member contributes to providing better health outcomes for the population.

The Risk Adjustment Coding Manager plays a crucial role in ensuring accurate medical coding and compliance with risk adjustment models.

• Hires and oversees the initial orientation and development of Risk Adjustment coding team members, including coding support specialists.
• Provides leadership, management, and ongoing training to Risk Adjustment coding support team members, including monitoring performance toward achievement of OKRs and assigned initiatives.
• Conducts monthly chart and phone audits for individual team members, providing feedback and direction as appropriate.
• Responsible for ongoing performance management of assigned direct reports.
• Serves as a key member of the Risk Adjustment leadership team, assisting with annual refinement, revision, and expansion of OKRs for the Risk Adjustment coding support team.
• Use data to identify areas of improvement for individual employees and that impact the team. Provide individual and team training on clinical documentation requirements, risk adjustment coding guidelines, and updates.
• Oversee and manage day-to-day risk adjustment coding team and operations, ensuring accurate and timely ICD-10 coding of claims via progress note clinical documentation review.
• Ensure compliance and quality for all coding practices maintaining high standards and adherence with federal regulations to ensure cohesive and compliant coding per the AHA ICD-10 coding guidelines, AAPC and AHIMA and internal policies.
• Conduct regular audits and quality checks for coding staff and practices to mitigate risk and ensure correct coding and clinical documentation requirements.
• Develop and provide ongoing training and support to health care providers on clinical documentation requirements, risk adjustment coding guidelines, and updates.
• Data analysis and reporting by running internal reports to analyze coding data for the identification of trends, areas for improvement, and potential compliance risks with preparation of detailed reports and/or presentation for internal and external use.
• Regularly connect with coders to by serving as a resource to improve team dynamics and communication by problem solving and addressing regular coding questions and issues.
• Collaborate with the coding director to develop policies, procedures, and workflows to enhance department efficiency.

Qualifications – Required

A degree in health information, healthcare administration, or a related field.

Certification in medical coding (CRC- Certified Risk Adjustment Coder) or demonstrated ability.

5+ years of experience in Risk Adjustment coding, with a focus on clinical documentation.

Technical proficiency, strong knowledge of coding languages within multiple EMRs with familiarity of coding standards and best practice.

Previous managerial experience or supervisory role with strong leadership to manage, motivate and lead a team of coders to ensure productivity and quality that includes training and supervising.

Effective verbal and written communication skills to interact with team members, practices, and other teams within Evolent.

Able to effectively train staff and collaborate to positively influence others with respect and compassion.

Problem-solving skills with the ability to identify and resolve coding issues efficiently.

Compliance knowledge, understanding industry standards and regulations in healthcare coding, specifically Risk Adjustment and all HCC models to ensure compliance with attention to detail to ensure accuracy in coding processes.

Strong knowledge of AHA ICD-10-CM coding guidelines, excellent analytical and problem-solving skills, and proficiency in clinical documentation requirements.

Qualifications Preferred

Clinical knowledge of chronic conditions and comorbidities.

Course work in human anatomy, physiology, and medical terminology.

Experience with developing and delivering provider education specific to the clinical documentation requirements for ICD-10 coding to the highest level of specificity.

Enthusiasm, strong work ethic, integrity, kindness and empathy, sense of humor, and an enjoyment of working in a collaborative, team-oriented environment.

Experience leading team members to be self-sufficient.

Ability to navigate ambiguity with the aid of structured problem-solving techniques.

Commitment to the practice of inquiry and listening.

Interest in being a part of a diverse and collaborative team.

To comply with HIPAA security standards (45 C.F.R. sec. 164.308 (a) (3)), identity verification may be required as part of the application process. This is collected for compliance and security purposes and only reviewed if an applicant advances to the final interview state. Reasonable accommodations are available upon request.

Evolent is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status. If you need reasonable accommodation to access the information provided on this website, please contact recruiting@evolent.com for further assistance.

The expected base salary/wage range for this position is $75,000 to $85,000. This position is also eligible for a bonus component that would be dependent on pre-defined performance factors. As part of our total compensation package, Evolent is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees. All compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts. Don't see the dream job you are looking for? Drop off your contact information and resume and we will reach out to you if we find the perfect fit!