HCC senior manager

Lead and mentor HCC coding and risk adjustment teams, including coders, auditors, and support staff.

Develop and manage performance metrics, productivity standards, and quality benchmarks.

Oversee training and ongoing education for team members to maintain coding accuracy and compliance.

Oversee end-to-end HCC coding processes including data collection, chart retrieval, coding review, validation, and submission.

Collaborate with providers, clinical documentation improvement (CDI), and analytics teams to ensure accurate and complete risk score capture.

Monitor and analyze risk adjustment data to identify trends, gaps, and opportunities for improvement.

Ensure adherence to CMS, ICD-10-CM, and other regulatory coding guidelines.

Manage internal and external audits, including RADV and compliance reviews.

Implement corrective action plans and quality assurance initiatives based on audit findings.

Partner with leadership to develop and execute strategies that optimize risk adjustment revenue and compliance.

Provide insights and reporting on coding accuracy, HCC capture rates, and risk score performance.

Stay current on regulatory updates, CMS guidance, and industry best practices.

Serve as a subject matter expert (SME) for HCC coding and risk adjustment processes.

Liaise with medical groups, health plans, and vendor partners to align on performance goals.

Support provider education initiatives on documentation and coding best practices.