Boston Medical Center (BMC) is hiring a Manager, Risk Adjustment Coding to lead the team responsible for accurate and compliant diagnostic coding. This role is central to developing and auditing workflows that enhance patient health, identify chronic conditions, and optimize reporting to payers.

What You'll Do

Manage the day-to-day operations of the Risk Adjustment Coding Team.
Develop, implement, and audit electronic medical record workflows to improve patient health and identify chronic disease conditions.
Create a unique data and reporting model to capture and optimize ICD-10 reporting to Payers.
Determine appropriate ICD10-CM diagnoses codes based on clinical documentation following Official Guidelines and Risk Adjustment guidelines.
Support management oversight of Coders and improve people, process, and technology across the function.
Partner with the Value Based Care Team to manage accurate coding practices, find documentation improvement opportunities, and optimize risk adjustment processes.
Establish KPIs for Risk Coding functions and implement action plans where performance is not meeting expectations.
Maintain current knowledge of regulatory and compliance changes impacting Risk Coding operations and ensure employee education.
Develop and implement quality improvement initiatives, including conducting regular audits, educating coders/clinicians, and monitoring KPIs.
Ensure compliance with all applicable Federal, State and/or County laws and regulations related to coding and documentation guidelines for Risk Adjustment.
Conduct reviews for clinical indicators and query providers to capture the severity of illness of the patient.
Measure Providers’ performance on important aspects of care and service.
Communicate relevant changes in performance, market trends, health care delivery systems, and legislative initiatives to the team(s).
Facilitate projects and conversations within BMCHS to share and develop standard processes.
Provide guidance and oversight for Risk Coding methodology, performance, and workflows.
Train new staff and provide ongoing education and training to existing staff.
Perform regular quality reviews and provide feedback on opportunities for improvement to the Risk Coding team.

What We're Looking For

Associates degree.
Coding Certification from AAPC or AHIMA (e.g., CRC, CPC, CDEO, CCS, CCS-P, CCA, RAC, RHIT, RHIA).
Minimum of four (4) years progressive coding and/or coding leadership experience in Risk Adjustment Coding.
Knowledge of AHA coding guidelines and methodologies: HCC’s and other RA methodologies, ICD-10-CM coding guidelines, OIG and Federal and State regulations.
Extensive knowledge of medical terminology, anatomy, pathophysiology, pharmacology, and ancillary test results.
Experience with an Electronic Medical Record (EMR).
Proficient with Microsoft Office applications (Outlook, Word, Excel).
Strong organization, analytical thinking, and critical thinking skills.
Strong communication skills (interpersonal, verbal and written).
Ability to work with accuracy and attention to detail.
Ability to solve problems appropriately using job knowledge and current policies/procedures.
Ability to work cooperatively with members of the healthcare delivery team and staff.
Ability to handle frequent interruptions and adapt to changes in workload and work schedule.
Must be able to maintain strict confidentiality of all personal/health sensitive information and ensure compliance of HIPAA rules and regulations.