Manager, Risk Adjustment Operations

Guided by our core values and commitment to your success, we provide health, financial and lifestyle benefits to ensure a best-in-class employee experience. Some of our offerings include :

Highly competitive total rewards package, including comprehensive medical, dental and vision benefits as well as a 401(k) plan that both the employee and employer contribute

Annual incentive bonus plan based on company achievement of goals

Time away from work including paid holidays, paid time off and volunteer time off

Professional development courses, mentorship opportunities, and tuition reimbursement program

Paid parental leave and adoption leave with adoption financial assistance

Employee discount program

Job Description Summary :

Manages and executes the Blue KC Risk Adjustment (RA) programs for Commercial (ACA). Manages Risk Adjustment coding, auditing and retrieval operations and if needed special projects within the risk adjustment programs.

Job Description

Manage all risk adjustment coding and chart retrieval activities to support retrospective and prospective retrieval campaigns, regulatory audits, and internal compliance monitoring.

Accountable for the performance , monitoring and improvement of our risk adjustment coding and chart retrieval operations which at times may include oversight of temporary coders and / or vendor services .

Coach and mentor team to achieve production numbers, maintain coding / abstraction / retrieval quality metrics, and comply with CMS / HHS coding guidelines

Accountable for the oversight of procurement and processing of all medical records needed to support contractual obligations, Government audits and Association requirements.

Track coding and chart retrieval production and ensure appropriate resources are dedicated to meeting our target production numbers

Coordinate with internal teams to ensure medical records are accurately processed for coding operations

Oversee and direct chart coding quality efforts to ensure the appropriate volume of overread / quality audits are conducted and the quality of the audits meets best coding practices

Act as the SME for our coding abstraction and record retrieval systems and funnel system improvements to technical teams that implement feature enhancements, process workflow enhancements, or operational efficiencies, serve as the administrator to ensure users are properly set up

Roll out and manage a process to identify areas for our coders to improve their coding documentation techniques and develop / coordinate coding education activities (using internal resources, external coding seminars, and other educational tools)

Collaborate across internal and external teams for all areas of coding , auditing and retrieval operations and if needed special projects within the risk adjustment programs

Communicate production numbers, production issues, and if needed propose resolution tactics to address production, system, and / or reporting issues

Develop policies, procedures, strategies and work methods to achieve department and business goals

Minimum Qualifications

• Bachelor's degree or an equivalent combination of education and experience required to perform the essential functions of the job
• 7 years' coding experience
• 5 years' risk adjustment experience
• CPC required
• CRC required within one year of hire

Preferred Qualifications

Blue Cross and Blue Shield of Kansas City is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to, among other things, race, color, religion, sex, sexual orientation, gender identity, national origin, age, status as a protected veteran, or disability.