Manager of HCC Coding and Audit

As our Manager of HCC Coding and Audit, you will be responsible for overseeing the HCC(Hierarchical Condition Category) coding and auditing team to ensure accurate and efficient coding of patient diagnoses for risk adjustment purposes.  This role involves managing coding operations ensuring compliance with coding guidelines and regulations, and collaborating with other departments to optimize coding processes.     You will perform compliance audits, including risk-based audits and quality review (QR) monitoring, as needed. Every day you will develop and maintain relationships with revenue cycle teams spanning all organizational levels including global partners to effectively articulate coding quality and education needs. The manager will also conduct coding research, answer coding questions, and serve as a subject matter expert in HCC coding compliance. To thrive in this role, you must be coding certified, have leadership experience, and enjoy working with various stakeholders and clients.

​Key Responsibilities

• You will be working with several different Electronic Health Records and host billing systems and encoders as applicable to the various R1 clients.
• You will help build a dedicated team of HCC coding professionals focusing on ICD-10-CM.
• Manage coding audits,  including internal QR monitoring reviews. Responsibility for planning, monitoring, following up, and escalating any concerns to ensure the coding audits within the audit work plan stay on track and are completed in within a timely manner.  
• Maintain audit documentation, including audit cycle steps, client policies and procedures and training materials. 
• Work closely with the Director of Coding to ensure timely delivery of necessary education based on audit results; and assist in the development discussions for Corrective Action Plans (CAPs) based on audit findings. 
• Create audit reports, and follow up emails with the assistance of templates and audit resources, and distribute following review and approval by leadership. 
• Communicate coding audit findings to auditors, leaders, and clients, including applicable references, as appropriate. 
• Manage the global coding team as well as domestic QA reviewers, including direct people leader tasks such as timecard review/approval, PTO review/approval, work assignments, productivity monitoring, employee engagement, and general staff oversight, including keeping team informed about expectations, performance, and organizational and/or process changes. 
• Serve as a coding subject matter expert. 
• Provide guidance on documentation requirements, coding queries, and recommend process improvements. 
• Keep current on coding changes, specifically as they relate to HCC and ICD-10-CM coding and billing guidelines. 
• Research and resolve coding and/or documentation inquiries using authoritative sources. 
• Assist in performing routine coding compliance audits as needed on domestic QA reviewers. 
• Collaborate with a broad spectrum of service lines and professionals, ranging from senior management to front line site and service leaders to clients and vendors. 

Required Qualifications

• Active coding credential: CCS, CCS-P, or CPC required. CPC-A is not applicable.
• CRC preferred
• Strong knowledge of CMS HCC coding guidelines and regulations.
• Previous leadership or management experience including communication and interpersonal skills as this is a client facing position.
• Knowledge of federal health care program statutes, regulations, rules and guidance regarding reimbursement, condition of payments and other material requirements. 
• Experience working with multiple EMRs, systems, clients, and contracts
• Successful relationship building and credibility with key stakeholders and subject matter experts in relevant service lines. 

The healthcare system is always evolving — and it’s up to us to use our shared expertise to find new solutions that can keep up. On our growing team you’ll find the opportunity to constantly learn, collaborate across groups and explore new paths for your career.

Our associates are given the chance to contribute, think boldly and create meaningful work that makes a difference in the communities we serve around the world. We go beyond expectations in everything we do. Not only does that drive customer success and improve patient care, but that same enthusiasm is applied to giving back to the community and taking care of our team — including offering a competitive benefits package.

R1 RCM Inc. (“the Company”) is dedicated to the fundamentals of equal employment opportunity. The Company’s employment practices , including those regarding recruitment, hiring, assignment, promotion, compensation, benefits, training, discipline, and termination shall not be based on any person’s age, color, national origin, citizenship status, physical or mental disability, medical condition, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status or any other characteristic protected by federal, state or local law. Furthermore, the Company is dedicated to providing a workplace free from harassment based on any of the foregoing protected categories.

If you have a disability and require a reasonable accommodation to complete any part of the job application process, please contact us at 312-496-7709 for assistance.

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To learn more, visit: R1RCM.com

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