Manager, Coding Audits and Compliance
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Job Location:
Somerville, NJ - USA
Monthly Salary:
$ 99465 - 141804
Posted on:
4 days ago
Vacancies:
1 Vacancy
Job Summary
Mass General Brigham relies on a wide range of professionals including doctors nurses business people tech experts researchers and systems analysts to advance our mission. As a not-for-profit we support patient care research teaching and community service striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.
Job Summary
Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham we are at the forefront of transformation with one of the worlds leading integrated healthcare systems. Together we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage.Our work centers on creating an exceptional member experience a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds experiences and skills.
We are pleased to offer competitive salaries and a benefits package with flexible work options career growth opportunities and much more.
Oversees the coding audit and compliance aspects of risk adjustment partnership with key stakeholders the role supports the management of oversight of offshore vendors and continuously works to improve people processes and technology across the function. The Risk Coding Audit team works to manage accurate and compliant coding practices find opportunities for documentation improvement optimize risk adjustment processes and support revenue cycle management. The position applies knowledge of key business drivers and the factors that improve the Risk Adjustment departmental performance and anticipates business and regulatory issues and trends to identify improvements.
Essential Functions
-Oversee daily risk coding audit operations to ensure compliance with regulations and standards.
-Provide leadership and guidance to the coding audit team ensuring proper training and adherence to coding guidelines.
-Establishes KPIs for risk coding functions; ensures the implementation of action plans when performance does not meet expectations.
-Conduct audits and reviews of coding practices to identify and address discrepancies.
-Lead end-to-end RADV efforts coordinating cross-functional teams managing audit preparation and submissions and ensuring timely and compliant responses to CMS and external auditors.
-Implement and monitor risk mitigation strategies related to coding practices.
-Provides direction and oversight across MGBs Risk Coding methodology performance and workflows.
-Stay updated on changes in coding regulations and communicate these changes to the team.
-Develop and enforce policies and procedures to maintain coding accuracy and integrity.
-Prepare and present reports on coding performance and risk areas to senior management.
-Oversee vendor management and proper compliance with internal and external required procedures
Qualifications
Education
- Bachelors Degree ( Health Information Management Nursing or another related field of study) required; experience can be considered in lieu of a degree
Licenses and Credentials
- Certified Risk Adjustment Coder (CRC) - Required within 6 months of start date
- Certified Professional Coder (CPC) - Preferred
- Certified Coding Specialist (CCS) - Preferred
Experience
- At least 5-7 years of experience in medical coding risk coding or RADV audits required
- At least 1-2 years of experience in a management or supervisory role required
Knowledge Skills and Abilities
- In-depth knowledge of coding standards including ICD-10 CPT and HCPCS.
- Strong leadership and team management skills.
- Excellent attention to detail and analytical skills.
- Proficiency in coding software and electronic health records (EHR) systems.
- Effective communication skills both written and verbal.
- Ability to work collaboratively across departments to achieve organizational goals.
- Strong problem-solving abilities and the capacity to manage risk.
- Commitment to continuous learning and staying informed on coding regulations.
Additional Job Details (if applicable)
Working Conditions
- This is a remote role that can be done from most US states
Remote Type
Work Location
Scheduled Weekly Hours
Employee Type
Work Shift
Pay Range
$99465.60 - $141804.00/AnnualGrade
8EEO Statement:
Mass General Brigham Competency Framework
At Mass General Brigham our competency framework defines what effective leadership looks like by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance make hiring decisions identify development needs mobilize employees across our system and establish a strong talent pipeline.
Required Experience:
Manager
About Company
Patients at Mass General have access to a vast network of physicians, nearly all of whom are Harvard Medical School faculty and many of whom are leaders within their fields.
