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Job Information

AdventHealth RAF Coding Manager PHSO in Maitland, Florida

Description

Location Address: 101 Southhall Lane, Maitland, FL 32751

Top Reasons To Work At AdventHealth Corporate

  • Great benefits

  • Immediate Health Insurance Coverage

  • Career growth and advancement potential

Work Hours/Shift:

  • Full-Time, Monday – Friday

You Will Be Responsible For:

  • Responsible for the execution and daily management of the Risk Adjustment Program while, providing leadership and participation in risk meetings as an active member of the team, to discuss policy, strategy, implementation, administration, goals, progress, and improvement of the risk program.

  • Monitoring programs to ensure regulatory and contractual compliance

  • Manages direct reports in the RAF department

  • Implements coaching and training plans

  • Assists in setting goals and plan of Risk Adjustment and CDI program (In conjunction with the Director of RAF)

  • Assists in training and coaching health plan and clinicians on Risk Adjustment concepts and critical success factors

  • Works with compliance, finance, and Quality to ensure compliance with CMS rules and regulations in order to prepare for RADV audits

  • Assists in training of health plan staff and providers on proper coding and documentation requirements

Qualifications

What You Will Need:

  • Minimum 5 years of experience in RAF coding

  • 1 years’ experience as a manager/supervisor

  • Bachelor’s degree in business, health care, or related field.

  • CDIP, CCDS or CPC (Clinical Documentation Improvement Practitioner/Certified Clinical Documentation Specialist/Certified Professional Coder)

Job Summary:

The Population Health Services Organization (PHSO) RAF Manager will be responsible to design, secure executive commitment, develop and lead a broad and diversified range of risk adjustment coding services for the AdventHealth Population Health Risk Adjustment and CDI Program. This will include but not be limited to developing the overall structure and operations to support programs in Risk Adjustment coding, CDI review, Communication protocols, and Quality Assurance (QA) and compliance programs to effectively meet targeted engagement, clinical and economic outcomes. Ensure that risk adjustment related programs are performing and compliant and in all regulatory mandated and contractual quality activities. Monitor key program and population metrics, as well as participate in quality improvement efforts serving as a risk adjustment coding resource for network physicians, PHSO committees, members, medical services, health management, and member service staffs as well as other internal and external partners. Responsible for actively identifying opportunities of improvement and developing and driving annual clinical initiatives related to the risk adjustment coding management for the populations served. RAF topic educator and training resource to population health services and programs to PHSO and Integrated delivery system partners. Additionally, responsible for reviewing and identifying any opportunities in coding policies and procedures and providing clinical and economic data necessary to make recommendations.

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.

We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.

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