National Director, Risk Adjustment

The National Director Risk Adjustment identifies and implements initiatives to achieve complete and accurate coding goals across all markets. This role collaborates and communicates extensively with Market and Provider Clinician Leadership to identify improvement opportunities establish clear goals and facilitate the implementation of effective solutions that are scalable with repeatable outcomes. As a partner to market management and SMEs this includes interfacing in the market with individual Care Centers as mutually determined between the director and the market. The Director is comfortable navigating a matrixed environment and cultivates strong partnerships with key stakeholders across various departments to integrate complete and accurate coding principles and tactics into their workflows. This leader monitors corporate and market performance and also partners with analytics data and technology internal and external (EHR for instance) teams to enhance and automate tactics and develop  timely and meaningful reporting. As the internal subject matter expert on risk adjustment models this individual promotes and adheres to the tenets of coding compliance and aligned educational programs.

• Collaborate with Market and Provider Leadership and market SMEs to identify opportunities and tactics to improve complete and accurate coding performance document specific goals facilitate discussion and discovery of solutions across markets and lead and/or facilitate the implementation of processes across all markets.

• Manage projects to enable complete and accurate coding including those that require vendor assessment contracting implementation and management and the  coordination of clinician and Privia market and national teams.

• Cultivate collaborative relationships with key stakeholders across RCM Finance Platform Engineering and other departments to ensure effective integration of risk adjustment principles into their workflows utilizing strategies such as attending staff meetings and fostering leader buy-in.

• Partner closely with data and technology teams to continuously improve timely and meaningful reporting and insights at the point of care for all providers (platform and non-platform) and through to payers.

• Serve as the internal subject matter expert on the current Hierarchical Condition Category (HCC) Risk Adjustment models.

• Responsible for the management of one or more staff members and their professional development.

• In partnership with Privias Compliance leader maintain a focus on coding compliance; develop models for chart review audit and education that minimize risk and promote thorough patient care. 

• Conduct training from time to time with individual and large provider groups particularly in new markets.

Qualifications :

• Bachelors degree required

• Minimum of 3 years experience in leadership position in risk adjustment

• Certified Professional Coder (CPC) required; CPC and Certified Risk Adjustment Coder (CRC) preferred

• Knowledge of Federal laws and regulations including laws 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 codes

• Familiarity with Electronic Medical Records (athenahealth preferred) Encoder Coding Clinic G-Suite other software programs and internet based applications as needed to fulfill position duties

• Possess an understanding of healthcare billing compliance including the prevention of upcoding and other regulatory requirements.

• Maintain patient team member and employer confidentiality; comply with all HIPAA regulations

The salary range for this role is $125000.00-$150000.00 in base pay and exclusive of any bonuses or benefits (medical dental vision life and pet insurance 401K paid time off and other wellness programs). This role is also eligible for an annual bonus targeted at 20% and restricted stock units. The base pay offered will be determined based on relevant factors such as experience education and geographic location. 

Additional Information :

All your information will be kept confidential according to EEO guidelines.

Technical Requirements (for remote workers only not applicable for onsite/in office work):

In order to successfully work remotely supporting our patients and providers we require a minimum of 5 MBPS for Download Speed and 3 MBPS for the Upload Speed. This should be acquired prior to the start of your employment. The best measure of your internet speed is to use online speed tests like This gives you an update as to how fast data transfer is with your internet connection and if it meets the minimum speed requirements. Work with your internet provider if you have questions about your connection. Employees who regularly work from home offices are eligible for expense reimbursement to offset this cost.

Privia Health is committed to creating and fostering a work environment that allows and encourages you to bring your whole self to work. We understand that healthcare is local and we are better when our people are a reflection of the communities that we serve. Our goal is to encourage people to pursue all opportunities regardless of their age color national origin physical or mental (dis)ability race religion gender sex gender identity and/or expression marital status veteran status or any other characteristic protected by federal state or local law.  

Remote Work :

Yes

Employment Type :

Full-time