Risk Adjustment Coding Coordinator

Site: Mass General Brigham Health Plan Holding Company, Inc.

Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.

Job Summary

The Risk Adjustment Coder works to improve the coding and quality aspects of risk adjustment processes. In partnership with key stakeholders, supports management of oversight of vendors and continuously works to improve people, processes, and technology across the function. The position works to manage accurate and compliant coding practices, find opportunities for documentation improvement, optimize risk adjustment processes, and support revenue cycle management.

Essential Functions

• Actively contributes to the strategic direction for Risk Coding and collaborates with vendor partners to lead volume and ensure adherence to agreed upon SLAs.
• Establishes KPIs for risk coding functions; ensures the implementation of action plans when performance does not meet expectations.
• Communicates relevant changes in performance, market trends, healthcare delivery systems, and legislative initiatives impacting the execution of team goals to team(s).
• Provides direction and oversight across the organization's Risk Coding methodology, performance, and workflows.
• Monitors, implements, and contributes to financial planning provided by leadership to support a cost-effective Risk Coding strategy.
• Leads the offshore volume for risk coding and ensures vendors are held to agreed-upon SLAs.
• Develop and implement quality improvement initiatives; examples include conducting regular audits, educating coders/clinicians, and monitoring KPIs for improvements.
• Conduct training and education sessions for healthcare providers and coding staff on risk adjustment coding requirements and best practices.
• Performs other duties as assigned
• Complies with all policies and standards
  
  

Qualifications

Education

• Bachelor's Degree preferred
  
  

Licenses and Certifications

• Certified Risk Adjustment Coder (CRC)® certification
  
  

Experience

• At least 1-2 years of experience in medical coding or risk adjustment coding required
  
  

Knowledge, Skills, And Abilities

• In-depth knowledge of ICD-10, CPT, and HCPCS coding systems, particularly as they relate to risk adjustment.
• Strong analytical abilities to assess coding accuracy and identify areas for improvement.
• Excellent verbal and written communication skills for effective training and collaboration with clinical staff and coding teams.
• High level of accuracy and attention to detail in coding and documentation processes.
• Familiarity with healthcare regulations and guidelines related to risk adjustment and coding compliance.
  
  

Additional Job Details (if Applicable)

Working Conditions:

• This is a remote role that can be done from most US states. Local employees attend meetings 1x/month in the office.
  
  

Remote Type

Remote

Work Location

399 Revolution Drive

Scheduled Weekly Hours

40

Employee Type

Regular

Work Shift

Day (United States of America)

Pay Range

$78,000.00 - $113,453.60/Annual

Grade

7

At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.

EEO Statement

Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.

Mass General Brigham Competency Framework

At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.