Director of Risk Adjustment
Summit Medical Group is East Tennessee's largest primary care organization with more than 300 providers at 66 practice locations in 15 counties. Summit also consists of four diagnostic centers, mobile diagnostic services, eight physical therapy centers, four express clinics, central laboratory, extensivist clinic, and sleep services center. Summit provides healthcare services to more than 280,000 patients, averaging over one million encounters annually. For more information, visit www.summitmedical.com
In addition to our commitment to the health of our community, our organization is also committed to the health of our employees through our employee Wellness Program. Employees receive a discounted monthly insurance premium if they actively participate in the wellness program. Furthermore, Summit Medical Group hires only non-tobacco users. Pre-employment drug testing will include testing for nicotine, and only candidates who pass the drug test will be considered eligible for employment.
About Our Career Opportunity
As Summit Medical Group in Knoxville, Tennessee continues to commit to value based care based on measurable quality health outcomes, our organization is seeking a Director of Risk Adjustment . The Director of Risk Adjustment is responsible for day to day operations of Coding Support and Pre-Visit Planning staff for Risk Adjustment projects and other projects as deemed necessary by the Company. This person will be the subject matter expert on risk coding for the organization. This role requires residence in the Knoxville, Tennessee area.
Examples of Duties (List does not include all duties assigned)
- Fosters a culture for best practices sharing, peer service orientation, measurement, accountability, and continuous improvement.
- Oversees the workflows for medical chart audits for both retroactive and prospective basis to identify, and monitor documentation as it relates to the Hierarchical Condition Categories (HCC).
- Review internal controls, policies and procedures to ensure compliance with appropriate SMG, Stated and Federal guidelines and procedures.
- Oversees coding abstraction and medical chart quality audits to ensure clinicians have accurate clinical documentation to support ICD-10 codes and are adhering to CMS Risk Adjustment guidelines.
- Provide clinician onboarding, annual and/or as needed education on specific coding issues and opportunities found in their charts.
- Ensures reimbursement is maximized through appropriate coding via implementation of best practices and processes.
- Manages annual recoding efforts.
- Works directly with Decision Support to develop / enhance reporting showing coding trends.
- Remains up to date with all industry coding and compliance issues to act as the subject matter expert for the organization.
- Engages health plans and government agencies.
- Collaborates with senior management to develop strategies and tactics that improve the accuracy of risk scores and reduce payment error risk.
- Hires, trains, coaches, counsels, and evaluates performance of direct reports.
- Performs other duties as assigned.
Education- 2 years' post high school education or a degree from a two-year college. RHIT undergraduate degree prefer. Education may be waived in lieu of experience.
- Clinical experience and experience with ICD 10 & CPT coding in an ambulatory setting required.
- CMS HCC Risk Adjustment Coding experience required.
- Previous management experience required.
- Experience working with all lines of business (Medicare, Medicaid, and Commercial).
Certification/License- Certification as a CCS, CCS-P, CPC, CPC-H or CRN-C required. Active nursing license preferred (Registered Nurse or Licensed Practical Nurse).