Strive Health
health care
Manager,CodingOperations
Neural analysis suggests this role is
optimal for Senior candidates.
“Manager, Coding Operations at Strive Health. Skills: process management, cross-functional coordination, vendor/stakeholder management, operational metrics, resource planning, continuous improvement. Manages and trains/orients assigned personnel. Evaluates coder performance and disciplinary actions, provides developmental coaching, reviews and submits timesheets”
What You'll Achieve.
95% accuracy adherence; adequacy of proper diagnosis, procedure and modifier assignment
Industry & Context.
clinical assessment; critical thinking skills; conflict and resolution of problems
Ability to travel and be onsite to meet business needs
What They're Looking For.
Must Have
5+ years related experience in health care and managed care settings, 5+ years experience in medical record review, healthcare payment and coding methodologies, (i. e. ICD 10-CM, CPT, HCPCS, DRG, HCC coding and RADV audits), 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, Experience with different MA, ESRD, and ACA HCC Models, Knowledge of Federal laws and regulations, including NCDs and LCDs affecting risk adjustment documentation and coding compliance, MS Office Suite, Electronic Medical Records, Encoder, and other software programs and internet-based applications, 2+ years managing high performing coding production teams, Internet Connectivity - Min Speeds: 3. 8Mbps/3. 0Mbps (up/down): Latency <60 ms, Ability to travel and be onsite to meet business needs
Nice to Have
Medical Coding Certification, Certified Professional Coder(CPC) or Certified Risk Adjustment Coder (CRC) preferred, Experience in managing remote production based teams, In-depth experience in Medicare Risk Adjustment processes and impacts, Retrospective vendor chart review, Expert in coding and documentation guidelines, knows how to develop relationships with clinicians, ability to work collaboratively and cross-functionally in a fast-paced, often changing environment, Understanding of Value Based Care
What You'll Do.
Manages and trains/orients assigned personnel
Evaluates coder performance and disciplinary actions
provides developmental coaching
reviews and submits timesheets
Monitors productivity and performs monthly QA audits of coders for 95% accuracy adherence and adequacy of proper diagnosis
procedure and modifier assignment
Develops corrective action plans
including education as necessary
Reports on all coding KPI’s to Director of Risk Adjustment Coding Operations
Develops and maintains coding department workflows
policies and procedures
Establishes workload assignments and necessary adjustments for assigned team members
Assists in monthly ASM abstraction and submission
Works closely with Director of Risk Adjustment Coding operations and coding leads to identify HCC and ProFee coding trends or issues for providers and team members
Provides additional oversight of Risk and ProFee coding processes and procedures to assure proper application of ICD-10 CM
CPT and CPT II/HCPCS coding and compliance policies
Develop and implement coding education and training for team members and providers as necessary
Serves as the source for coding escalation questions and resolutions
Assist with conducting internal physician chart audits for reimbursement utilization (includes research and presentation)
Works and communicates with various departments within the organization related to HCC and procedural coding and compliance
risk and HEDIS enablement
and network provider team members
Responsible for maintaining current knowledge of coding guidelines and relevant federal regulations through use of current CPT
HCPCS II and ICD-10CM materials
the Federal Register and other pertinent materials
How You'll Work.
Team & Collaboration
Works closely with Director of Risk Adjustment Coding operations and coding leads to identify HCC and ProFee coding trends or issues for providers and team members; Works and communicates with various departments within the organization related to HCC and procedural coding and compliance, including billing, finance, analytics, compliance, risk and HEDIS enablement, and network provider team members; ability to work collaboratively and cross-functionally in a fast-paced, often changing environment; Ability to effectively manage remote team members
Communication Scope
queries/communications; Excellent verbal and written communication skills; Excellent interpersonal communication skills
Process & Methodology
process management, cross-functional coordination, resource planning
Full Job Description
How You’ll Make An Impact At Strive Health, patients come first. We’re on a mission to transform chronic conditions by identifying risk earlier, coordinating thoughtful care, and supporting people through every stage of their health journey. Our work reduces emergency visits, improves outcomes, and helps patients live fuller lives. You’ll work alongside passionate Strivers who care deeply about making an impact, show up for one another as One Team, and find ways to elevate the everyday. If you’re looking for meaningful work where your contributions truly matter, you’ll feel right at home at Strive! Benefits coding, turn-around times, accuracy, queries/communications, denial issues, error trends, and provide clinician education support. Manages and trains/orients assigned personnel. Evaluates coder performance and disciplinary actions, provides developmental coaching, reviews and submits timesheets. Monitors productivity and performs monthly QA audits of coders for 95% accuracy adherence and adequacy of proper diagnosis, procedure and modifier assignment. Develops corrective action plans, including education as necessary. Reports on all coding KPI’s to Director of Risk Adjustment Coding Operations. Develops and maintains coding department workflows, policies and procedures. Establishes workload assignments and necessary adjustments for assigned team members. Assists in monthly ASM abstraction and submission. Works closely with Director of Risk Adjustment Coding operations and coding leads to identify HCC and ProFee coding trends or issues for providers and team members. Provides additional oversight of Risk and ProFee coding processes and procedures to assure proper application of ICD-10 CM, CPT and CPT II/HCPCS coding and compliance policies. Develop and implement coding education and training for team members and providers as necessary. Serves as the source for coding escalation questions and resolutions. Assist with conducting internal physician chart audits for r
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