Manager, Risk Adjustment & CDI

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Company Description

Valley Steer is a dynamic healthcare technology startup leveraging AI and machine learning to revolutionize the risk adjustment process for large national health plans and other risk-bearing entities. Our agile team disrupts traditional approaches by streamlining chart review, clinical documentation improvement, coding extraction, and payment acceleration to maximize revenue and accuracy. We are dedicated to enhancing the efficiency and satisfaction of primary care physicians (PCPs) in value-based care settings by building strong, supportive relationships that allow providers to focus on exceptional patient care while ensuring they receive maximum allowable payments for services. 

Role Description

The Manager of Risk Adjustment & CDI will serve as the bridge between clinical care and medical coding, ensuring that patient records accurately reflect the care provided. This team member will be responsible for managing and reviewing medical records and other coders' documentation to ensure accurate Risk Adjustment coding and compliance. Additionally, this role requires a dynamic operator capable of building and running cross-functional processes between our customers and our global teams. The ideal candidate will have significant experience in Risk Adjustment coding, clinical documentation improvement (CDI), and auditing, along with a strong ability to manage remote global teams and maintain client-facing communication.

Key Responsibilities

Perform thorough reviews and audits of medical records and oversee the coding documentation of other coders to extract and code ICD-10, Hierarchical Condition Categories (HCC v24 and v28), and CPT codes according to current official guidelines. Utilize recognized clinical documentation improvement (CDI) guidelines to ensure documentation accuracy and compliance. Stay updated with the latest coding compliance regulations to ensure all coding activities meet current standards, including CMS audit processes. Provide guidance and training to our clients and our remote coding teams on coding issues, documentation improvements, and audit findings. Thread coding requirements between our clients and our coding teams, ensuring we are satisfying our customers’ unique coding guidelines.Develop and implement effective auditing practices and tools based on national documentation and coding guidelines. Create detailed reports, track and trend audit results, and make appropriate judgments on findings. Demonstrate subject matter expertise in Risk Adjustment, particularly to guide the client with business and operational strategies. Build and manage cross-functional processes across customers and global teams, ensuring smooth operations. Communicate effectively with clients, providing exceptional service and addressing any concerns. Manage remote teams, ensuring productivity and quality of work, and coordinate with teams in different locations.Willingly able to learn new skills and competencies. Travel occasionally within the US and internationally as required.

Licensure

Ongoing AAPC Certified Risk Adjustment Coder (CRC) is required. Ongoing AAPC Certified Professional Coder (CPC) is required.

Education and Training

At least 5 years of Risk Adjustment coding experience, including ICD-10 codes and HCCs (v24 and v28) in a health plan or medical group setting. Clinical documentation improvement (CDI) experience is required.Medicare Risk Adjustment documentation and coding auditor experience is required. Quality Measure/HEDIS experience is required. CPT coding experience is required.

Skills

Proficiency in MS Office Suite (Outlook, Excel, Word, PowerPoint) and Google Suite (Gmail, Drive, Docs, Sheets, Slides).Proficiency in teleconferencing and messaging software (MS Teams, Zoom, Slack). Proven experience in performing medical record coding and auditing.Understanding of billing processes. Exceptional client-facing communication skills.Strong ability to manage and lead remote global teams.S trong organizational skills with the ability to plan and complete work within targeted timeframes.Demonstrated ability to develop reports, track and trend results. Ability to interpret national documentation and coding guidelines effectively.Project management background is preferred.

Benefits

Competitive compensation package (based on experience and skill level). Unlimited paid time off (PTO). Opportunities for professional growth and development. Supportive and collaborative work environment. Flexible hours with minimal meetings. Remote work options.

Equal Opportunity Employer

We are an equal opportunity employer and value diversity. All employment decisions are based on qualifications, merit, and business needs. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.

Application Process

Interested candidates are encouraged to apply by submitting their resume to recruiting@valleysteer.com. Please highlight your relevant experience and why you are a suitable candidate for this role.