Risk Adjustment Program Manager

Under the direction of the Associate Director of Revenue Integrity, the Risk Adjustment Program Manager is responsible for overseeing all aspects of the UI Health Care Risk Adjustment Program and supervision of the Risk Coding team. This position plays a pivotal role in ensuring success in government and commercial risk-adjusted contracts and programs through accurate and complete diagnosis coding and documentation, provider engagement and education, and risk adjustment performance management. The Risk Adjustment Program Manager ensures the program is high-functioning, efficient, and aligned with industry best practices to optimize risk-adjusted payment models, support population health objectives, and improve patient outcomes. The role is part of a matrix structure, reporting directly to the Associate Director of Revenue Integrity, with a dotted line to the Associate Director of Population Health & ACO Operations.

Position Responsibilities:

•  Lead and manage the Risk Adjustment Program across the organization, ensuring that coding practices align with CMS guidelines and other regulatory requirements.

•  Continuously assess program performance and implement process improvements to increase efficiency, accuracy, and impact.

• Apply industry best practices in risk adjustment, coding, education, and workflow design to optimize program outcomes.

• Collaborate with clinical, operational, and financial leaders to integrate HCC coding into provider workflows and documentation processes.

• Serve as backup for risk coding team when necessary:
  • Review documentation available in the Medical Record to facilitate workflows that support the clinical picture/severity of illness/complexity of the patient care rendered to patients.
  • Utilize available coding resources to determine the appropriate ICD-10-CM diagnosis codes mapped to HCCs.
  • Actively participate in and maintain coding quality and productivity benchmarks.

• Collaborates with department and coding staff to conduct retrospective medical record reviews, ensuring accuracy and addressing quality concerns.
• Build and use dashboards and reports to monitor and analyze risk coding data - identify performance trends, gaps, and opportunities for targeted intervention. Build relationships with departmental and clinical leadership and hold regular multi-disciplinary meetings to provide actionable feedback to departments and clinical teams.
• Provide ongoing feedback to physicians and other providers regarding coding guidelines and requirements.
• Develop and implement educational programming for providers, departments, and clinic staff relating to risk coding and documentation compliance, as well as new policies and procedures.

• Understand organizational value-based and population health strategic direction, and work to align risk adjustment programmatic efforts in support.

• Engage with cross-functional teams and stakeholders, fostering a culture of collaboration and continuous improvement.

• Develop key performance metrics and track progress toward organizational risk adjustment goals.

• Stay up to date with changes in risk coding regulations, providing updates and recommendations on evolving regulatory requirements and industry standards, ensuring organizational compliance, and implementing necessary updates to processes.

• Supervise risk coding staff. Monitor team performance and resource needs. Hold staff accountable to goals and outcomes. Onboard and train new risk coding staff, as needed.