Manager/Senior Manager HCC

HCC Medical Coding Manager – Roles & Responsibilities

1. Coding Operations Management

• Supervise day-to-day coding activities related to HCC/Risk Adjustment.
• Allocate resources and assign work to ensure timely and accurate coding.

2. Quality Assurance

• Monitor coding accuracy and compliance with CMS guidelines, ICD-10-CM coding conventions, and official coding policies.
• Review coder audits and implement corrective actions when accuracy falls below thresholds.

3. Compliance & Risk Adjustment

• Ensure coding practices comply with CMS and HHS guidelines, as well as organizational standards.
• Support Risk Adjustment Factor (RAF) optimization efforts by ensuring all eligible diagnoses are captured.

4. Training & Development

• Provide regular training sessions on HCC coding updates, documentation improvement, and audit readiness.
• Coach and mentor coding staff to improve productivity and accuracy.

5. Documentation Improvement Support

• Collaborate with providers and clinical documentation improvement (CDI) teams to enhance diagnosis documentation.
• Educate clinicians on accurate documentation to support HCC capture.

6. Reporting & Metrics

• Prepare coding performance reports (accuracy, productivity, audit results) for leadership.
• Track KPIs and identify trends or areas of concern.

7. Audit Readiness

• Ensure coding teams are prepared for both internal and external audits (e.g., RADV, retrospective reviews).
• Address audit findings and lead remediation initiatives.