Job Description
Job Description
Summary
The Supervisor of Risk Adjustment (RA) Auditing and Coding reports to the Risk Adjustment
Manager. S/he performs duties to conduct the day-to-day operations of the Risk team functions
by communicating with other operational departments and Provider Offices. S/he will
participate in the development, implementation and performance of workflows for auditing
electronic medical records aimed at improving the health and well-being of patients and proper
identification of Chronic Disease Conditions as well as working to create a unique data and
reporting model to capture and optimize ICD10 reporting to Payers to improve quality for our
patients and reduce healthcare costs for our clients.
Essential Duties and Responsibilities include the following. Other duties may be assigned.
• Ensure compliance with all applicable Federal, State and/or County laws and regulations
related to coding and documentation guidelines for Risk Adjustment.
• Review medical records, patient medical history and physical exams, physician orders,
progress notes, consultation reports, diagnostic reports, operative and pathology reports,
and discharge summaries in order to verify whether:
• The diagnosis codes are supported by the documentation and ensure with ICD-10-CM
Guidelines for Coding and Reporting.
• The diagnosis codes for each chronic or major medical condition have been captured and
submitted within the permitted timeframe.
• Any diagnosis code identified as being unsubstantiated by the record must be submitted
to the carrier within timely guidelines to ensure on supported codes remain on record
with those carriers.
• Review 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.
• Ensure the highest level of customer satisfaction possible.
• Communicates and coordinates reviews with Quality Programs Educator and Support
Services for use in provider/staff training sessions.
• Facilitates and coordinates reporting to leadership within the organization as requested
• Provides clear, concise and professional communication to varying audiences depending
on the project and its goals.
Human Resources Job Description: (Risk Adjustment Supervisor) Rev. 2/11/2021
• Supports the RA Team in a positive manner with emphasis on providing excellent service
to all patients, providers, internal and external customers.
• Communicates to supervisor and IT Department regarding defects identified in the
reporting systems or data base, suggests performance improvement opportunities and
tracks through completion to insure revenue capture.
• Demonstrates excellent time management, attends and contributes to required meetings
which may include travel as well as hours outside of standard business hours and/or
above 40 hours per week.
• Demonstrates the ability to train new staff or provide ongoing education and training to
existing staff along with regularly performing quality reviews and including feedback on
opportunities for improvement to the Risk Coding team.
• Leads and empowers risk team through coaching, rounding, goal setting and monitoring.
Supervisory Responsibilities
Directly supervises assigned employees in the Risk department. Carries out supervisory
responsibilities in accordance with the organization's policies and applicable laws.
Responsibilities include interviewing, hiring, and training employees; planning, assigning, and
directing work; appraising performance; rewarding and disciplining employees; addressing
complaints and resolving problems.
Education and/or Experience
Bachelor's degree from four-year college or university; or two - three years related experience
and/or training; or equivalent combination of education and experience. Must have one of the
following: CPC, CRC, RHIT or similar. Position requires flexibility in work hours, multitasking, and excellent computer skills.
Job Posted by ApplicantPro