Risk Adjustment Program Manager - Remote

Healthcare Administrative

Under the direction of the Associate Director of Revenue Integrity, the Risk Adjustment Program Manager is responsible for overseeing all aspects of the UI Health Care Risk Adjustment Program and supervision of the Risk Coding team. This position plays a pivotal role in ensuring success in government and commercial risk-adjusted contracts and programs through accurate and complete diagnosis coding and documentation, provider engagement and education, and risk adjustment performance management. The Risk Adjustment Program Manager ensures the program is high-functioning, efficient, and aligned with industry best practices to optimize risk-adjusted payment models, support population health objectives, and improve patient outcomes.

The role is part of a matrix structure, reporting directly to the Associate Director of Revenue Integrity, with a dotted line to the Associate Director of Population Health & ACO Operations.

Position Responsibilities :

Lead and manage the Risk Adjustment Program across the organization, ensuring that coding practices align with CMS guidelines and other regulatory requirements.

Continuously assess program performance and implement process improvements to increase efficiency, accuracy, and impact.

Apply industry best practices in risk adjustment, coding, education, and workflow design to optimize program outcomes.

Collaborate with clinical, operational, and financial leaders to integrate HCC coding into provider workflows and documentation processes.

Serve as backup for risk coding team when necessary :

Review documentation available in the Medical Record to facilitate workflows that support the clinical picture / severity of illness / complexity of the patient care rendered to patients.

Utilize available coding resources to determine the appropriate ICD-10-CM diagnosis codes mapped to HCCs.

Actively participate in and maintain coding quality and productivity benchmarks.

Collaborate with department and coding staff to conduct retrospective medical record reviews, ensuring accuracy and addressing quality concerns.

Build and use dashboards and reports to monitor and analyze risk coding data - identify performance trends, gaps, and opportunities for targeted intervention. Build relationships with departmental and clinical leadership and hold regular multi-disciplinary meetings to provide actionable feedback to departments and clinical teams.

Provide ongoing feedback to physicians and other providers regarding coding guidelines and requirements.

Develop and implement educational programming for providers, departments, and clinic staff relating to risk coding and documentation compliance, as well as new policies and procedures.

Understand organizational value-based and population health strategic direction, and work to align risk adjustment programmatic efforts in support.

Engage with cross-functional teams and stakeholders, fostering a culture of collaboration and continuous improvement.

Develop key performance metrics and track progress toward organizational risk adjustment goals.

Stay up to date with changes in risk coding regulations, providing updates and recommendations on evolving regulatory requirements and industry standards, ensuring organizational compliance, and implementing necessary updates to processes.

Supervise risk coding staff. Monitor team performance and resource needs. Hold staff accountable to goals and outcomes. Onboard and train new risk coding staff, as needed.

Required Qualifications :

• A bachelor's degree in healthcare administration, business, finance, or a related field, or an equivalent combination of education and experience, is required.
• Certification as CPC, CRC, CCS-P, CCS-H, RHIT, or RHIA is also required.
• 3 years of experience in risk adjustment coding
• 2+ years of experience leading coding programs, preferably in a large healthcare organization
• 1 year of supervisory experience
• Strong knowledge of HCC coding guidelines, CMS risk adjustment models, and regulatory requirements.
• Knowledge of insurance regulations and Medicare and Medicaid guidelines as related to clinical documentation and clinical indicators
• Strong ability to collaborate across departments and manage stakeholders in a complex, matrixed environment.
• Strong problem-solving and research skills
• Strong clinical knowledge related to chronic illness diagnosis, treatment, and management
• Ability to interpret CMS regulations and guidance
• Demonstrated ability to provide coding advice and education to a variety of audiences, including leadership and frontline coding staff.
• Ability to analyze complex clinical scenarios and apply critical thinking
• Proven ability to effectively plan, prioritize, and organize tasks to achieve strategic goals
• Excellent written, verbal, and interpersonal communication skills
• Proficiency with MS Word, PowerPoint, and Excel, including database and spreadsheet analysis
• Demonstrated experience working effectively in a welcoming and respectful workplace.

Desired Qualifications :

Application Process : To be considered, applicants must upload a cover letter and resume that clearly address how they meet the listed required and desired qualifications of this position. Job openings are posted for a minimum of 7 calendar days. Successful candidates will be required to self-disclose any conviction history and will be subject to a criminal background check and credential / education verification.

Up to 5 professional references will be requested at a later step in the recruitment process.

For questions, contact Sharon Walther at sharon-walther@uiowa.edu.

This position is not eligible for University sponsorship for employment authorization now or in the future.