Health Risk Adjustment Coder

At Blue Zones Health we are redefining what it means to live a vibrant and healthy lifestyle. Inspired by long-living cultures around the world, we strive to empower people to make simple and sustainable lifestyle changes that lead to longer, better and more fulfilling lives. If you are ready to help transform well-being and be a pivotal part of our team, we want to meet with you!

Position Summary

This position will own assigned client relationships, acts as a subject matter expert, and oversees the development and facilitation of the implementation of new and existing healthcare Risk Adjustment & Quality strategies at an advanced level. Guides and influences other departments and the lead on quality and risk adjustment initiatives. Local Provider support for short- and long-term strategy, program planning and implementation, patient campaigns, outreach tactics, facilitation educational programs, data collection efforts and develops and monitors key performance measurement activities.

This is a hybrid position with local travel required 2–3 times per week to provider practices.

The compensation range for this role is $70,000 - $90,000 annually depending on experience.

Key Responsibilities

• Serve as the subject matter expert (SME) and lead initiatives across prospective, retrospective, and concurrent MRA strategies.
• Lead risk adjustment operational programs aimed at monitoring, oversight, and compliance for risk score accuracy
• Responsible for the program to meet full compliance with state, federal and partner requirements.
• Drives industry best practices and performance results focusing on driving key KPIs (i.e. # visits, RAF score, AWV completion rate, coding accuracy chart reviews and HCC recapture)
• Manage a coordinated, cross functional and integrated processes across the organization to implement programs and streamline activities.
• Drive program goals and key performance indicators (KPIs) to ensure accountability across the organization.
• Partner with Finance, Analytics, and Vitality team to establish risk adjustment analytics for coding improvement opportunities, provider coding improvement opportunities, provider coding accuracy, risk score trending and tracking.
• Ensure accurate coding for documentation and chart reviews.
• Drive effective chart review documentation practices
• Educate both internal staff and provider groups to drive appropriate action and closure of identified care gap opportunities.
• Collaborate with payer partners, manage key vendor relationships, and perform oversight of vendors for performance management and service level adherence for assigned practices
• Ensure processes and tools required for best-in-class accurate recapture rate
• Assist provider engagement and operations teams to maximize efficiency for provider conducted risk and quality visits.
• Oversee and manage the compliance and performance of vendors or third-party administrators performing risk adjustment activities.
• Perform other duties as assigned

Required Education and Experience

Licensure & Certification (one or more required) :

Experience

Skills and Competencies

Working Conditions

For more information about Blue Zones Health, check us out at www.bluezoneshealth.com.

Blue Zones Health does not discriminate on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity or expression, age, disability, veteran status, or any other protected status under applicable law.