Risk Adjustment Operations Manager

Privia Health - Remote2.7

Full-timeEstimated: $73,000 - $97,000 a year
Overview of the Role:
The National Risk Adjustment Operations Manager is responsible for overseeing Privia Health’s national Risk Adjustment (RA) capabilities, including Training & Education, Concurrent Coding, and any other operational capabilities. The Manager will be directly responsible for providing leadership, planning and guidance to market Risk Adjustment Educators. Readily ensures communication, education and program process improvement is documented and achieved. They will work closely with all markets to build operational action plans and execute to goals, integrating with other relevant teams, such as Population Health, Analytics, and Performance.

Primary Job Duties:
Act as the internal subject matter expert and escalation point for Risk Adjustment capabilities for Market Teams and providers
Ensure HCC Concurrent Coding and Training programs are operating effectively and efficiently
Develop centralized training programs, such as webinars, recorded trainings, and/or training materials to support providers in risk adjustment
Implement risk adjustment programs in new markets as needed
Manage and triage Risk Adjustment (RA) provider emails
Review and sign-off on all third party developed guidelines
Work effectively with physicians, Non-physician practitioners (NPP), practice staff, health plan/other external parties and Privia multidisciplinary teams
Collaborate with the Population Health, Analytics and Performance teams to resolve issues and answer questions in a timely manner
Work with Analytics to understand performance at a National, Market, physician practice, and provider level to identify opportunities for improvement
Support RA Educators with ad hoc provider risk adjustment audits
Accurately follow documentation and coding guidelines and legal requirements to ensure compliance with federal and state regulatory bodies
Perform other related duties, which may be inclusive, but not listed in the job description

Minimum Qualifications:
Certified Professional Coder (CPC) required; Certified Risk Adjustment Coder (CRC) preferred
Five years’ experience coding ICD-10-CM; Previous experience with Risk Adjustment training
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
Experience with MS Office Suite, Electronic Medical Records, Encoder, Coding Clinic, Customer Relationship Management (CRM) or other software programs and internet based applications as needed
Maintain patient, team member and employer confidentiality; comply with all HIPAA regulations

Interpersonal Skills & Attributes:
Able to have honest, difficult conversations with providers about diagnosis documentation and code assignment
Ability to communicate effectively, verbally and in writing
Establish and maintain effective working relationships with providers, management, clients and staff
Excellent interpersonal and presentation skills
Express ideas clearly and effectively
Respond calmly and maturely in high pressure situations
Keep a positive attitude toward company, work, clients, management, and team members
Use a customer focused approach in dealing with conflict and resolution of problems

Physical Demands:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands; reach with hands and arms; climb stairs. The employee must occasionally lift or move up to 25 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus.

Privia Health is committed to providing equal employment opportunity to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law. In addition, Privia will provide reasonable accommodations for qualified individuals with disabilities. Privia's goal is for our people to reflect the communities that we serve and to increase the representation of women, people of color, veterans and individuals with disabilities in our organization.