Upvote
Downvote
PHO Risk Adjustment Manager
Share Job
- Suggest Revision
- The Hallmark Health PHO Risk Adjustment Manager will lead and grow an emerging coder team as well as perform coder related functions as part of the Coding Program for PHO community providers.
- This individual will have a solid understanding of risk based financial models, such as Medicare Advantage, Medicare Next Gen, Managed Medicaid and Commercial budget models (i.e., BCBS AQC Model) and how risk capture impacts financial results within these models.
- A key aspect of the role is the development, customization and presentation of risk adjustment educational principals and program results to PHO providers as appropriate for different providers and practice staff (MDs, NP/PAs, medical billers, etc
- Position responsibilities include overseeing risk capture performance, reporting and assisting with the following: coding, abstracting and analyzing/reviewing medical records for the PHO risk adjustment programs to ensure proper medical diagnoses are coded appropriately and that the members medical record documentation supports the codes accurately in accordance with CMS, CPT and ICD.10 guidelines.
- one of the following professional certifications from AHIMA or AAPC: Certified Professional Coder (CPC), Certified Coding Specialist (CCS or CCS-P), Certified Inpatient Coder (CIC), Certified Outpatient Coder (COC)
Active Job
Updated 5 days agoSimilar Job
Relevance
Active