ABOUT UCARE

UCare offers Medicare, Medicaid, Individual and Family health plans – powered by the hardest working people in the industry. Our people powered teams de-complicate, advocate and always go the extra mile to help our members. We serve with integrity, compassion and commitment to do right by members, providers and government partners. Above all, we come to work excited to provide members a path for the best health of their lives.

WORKING AT UCARE

Working at UCare is more than a career; it's a mission. A mission that defines us as professionals, unites us as an organization and shapes how we interact with our members and each other. Employees join UCare and stay because of the opportunity to have a purpose-driven job.

Our strong culture has established UCare as a Star Tribune Top 200 Workplace for 14 consecutive years since the awards program began. It’s a culture that embraces innovative ideas, strategic partnerships, and exemplary customer and provider experiences. Working at UCare is being a part of a people powered team dedicated to making a real difference in the lives of our members and communities.

Position Description

As the Risk Adjustment Oversight Lead, you will be responsible to develop, enhance, communicate and lead UCare's Risk Adjustment Oversight Program. UCare's Oversight Program is accountable to manage all facets of UCare's Risk Adjustment activities as it relates to data submissions to government agencies for risk adjustment payments based on diagnoses that are compliant with applicable laws, regulations and contractual requirements. You will work with the Audit Director to ensure UCare has effective program elements such as: policies & procedures, training & education, risk assessment, audit & monitoring, responding to detected offenses, developing corrective action initiatives, and effective lines of communication with the Compliance Officer and Disclosure Program.

• Develop, implement, maintain and document UCare's Risk Adjustment Oversight Program.

• Prepare and present presentations to the UCare Risk Adjustment Steering Committee. Lead and facilitate the Risk Adjustment Data Compliance Team meetings. Present at other committees, meetings, as needed.

• Ensure communications across multiple departments and to UCare leadership are effective.

• Ensure appropriate policies and procedures are in place and updated per UCare's policies. This includes key process functions including provider record retrieval processes and working with other areas of the company, as necessary.

• In partnership with Corporate Learning and Development, ensure adequate training and education is in place for employees and providers/coders.

• Develop, lead and execute the audit and monitoring plans for UCare's risk adjustment payments as it pertains to UCare and key vendor processes, making necessary adjustments, as needed. Audits and monitoring should be designed to ensure the accuracy and integrity of the data being submitted to regulatory agencies for risk adjustment payments to ensure they are based on diagnoses coding that are compliance with applicable laws, regulations and contract requirements.

• Perform clinical validation reviews of medical records to ensure the accuracy of diagnostic coding and adequacy of clinical documentation. Perform validation of diagnosis data submitted by external vendors. Document and report out on findings.

• Provide timely responses to any Risk Adjustment event occurrences. Facilitate the corrective action plan process with the business and/or providers and manage issues as they arise.

• Manage and facilitate risk adjustment data validation audits by government agencies or outside audit vendors.

• Drive the maintenance of internal chart review guidelines to ensure the accuracy of diagnoses data captured and submitted to regulatory agencies.

• Assess the need for provider education and assist in the development of educational materials related to compliant coding and risk adjustment practices.

• Comply with official coding guidelines and integrate coding principals during reviews while maintaining HIPAA privacy.

• Monitor and communicate changes related to Regulations, ICD-10-CM codes and the risk adjustment models.

• Maintain and communicate knowledge of risk adjustment regulatory requirements and serve as an internal resource for departments in implementing coding and process changes needed to meet compliance.

• Other projects and duties as assigned.

Education

Bachelor’s degree demonstrated experience may be considered in lieu of degree. Current and valid professional coding certification from an accredited institution.

Required Experience

Three years of progressive coding experience using ICD-9/ICD-10-CM, CPT and HCPCS. Three years of experience with risk adjustment coding (HCC). At least one year of coding, billing and compliance experience across a broad range of specialties and working with Medicare coding requirements. Experience in conducting audits and medical record reviews.

Preferred Experience

Experience with Data Validation audits. Clinical coding experience. Certified Risk Adjustment Coder (CRC)

THE UCARE DIFFERENCE

The UCare difference is our people power – employees actively working on the behalf of our members to get them access to the health care they need. We value and respect each individual's ideas and contributions, and provide the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, and a myriad of volunteer activities. If you're looking for an inclusive environment that celebrates your people power, helps you build on your strengths and gives you the opportunity to truly make a difference, we invite you to .