Supervisor, Risk Adjustment Coding

  • WellCare
  • Tampa, FL, USA
  • Apr 16, 2019
Full time Information Technology Telecommunications

Job Description

*Position can sit out of Tampa, Nashville, or Houston.

Supervise the daily operations and work flow of the Medical Coding Specialists ensuring that 100% of the retrieved charts are coded. Provide guidance to the RAPS Medical Coding specialists to ensure proper ICD-9 coding and CMS compliance.

Essential Functions:

  • The Supervisor, Medical Coding Specialists (S-MCS) supervises the daily operations and work flow of the Medical Coding Specialist (MCS) Team;
  • The S-MCS provides guidance and motivation to the MCS Team in their day to day job functions, actively mentoring and providing training as needed;
  • He/she ensures coding productivity and quality goals and objectives are consistently met;
  • The S-MCS provides ongoing training and continuing education to the Medical Coding Specialists regarding risk adjustment, proper ICD-9 coding, and ICD-10 coding through written materials, conference calls, Webinars, or presentations;
  • He/she serves on the RADV committee as a subject matter expert;
  • The S-MCS coordinates yearly continuing education unit (CEU) coder training seminars;
  • He/she conducts staff meetings on a weekly basis - instilling a team approach, focused on meeting productivity goals and compliance metrics;
  • The S-MCS works closely with the Mgr, Medical Coder Auditing to ensure that the MCS Team's coding is meeting and/or exceeding QA standards. Upon approval of the Director, Risk Adjustment, the S-MCS and the M-MCA will develop, implement, evaluate and improve coding policies and procedures and departmental operations as needed;
  • He/she serves as the MCA business representative for system enhancements (e.g. data entry tool design);
  • The S-MCS is accountable for understanding the intricacies of the ICD-9 coding guidelines and its application to risk adjustment coding;
  • An important function of the S-MCS is to prepare and submit to the Director, Risk Adjustment weekly productivity reports including key performance metrics and quarterly productivity trending reports. The S-MCS is responsible for researching industry best practices for productivity-enhancement processes, for understanding the financial impact of productivity, data capture and reporting tools, processes and systems to present to the Director, Risk Adjustment on a quarterly basis;
  • The S-MCS and the M-MCA develop mutually agreed upon corrective action plans, training sessions, and re-training programs to ensure that the QA standards are consistently met;
  • He/she ensures compliance with all applicable federal, state and local regulations, as well as with institutional/organizational standards, practices, policies and procedures;
  • The S-MCS assists in other projects as necessary.
  • The S-MCS reviews members' medical records from primary and specialist care providers to identify all ICD-9's that meet CMS and ICD-9 coding guidelines. Complete data entry for identified ICD-9's
  • The S-MCS is responsible for hiring, promoting, establishing PIP, establishing goals and objectives, conducting performance appraisals, approving time, and establishing P&P for the MCS.
Additional Responsibilities:

Candidate Education:

  • Required A Bachelor's Degree in a related field
Candidate Experience:
  • Required 5 years of experience in professional coding either in a hospital or physician setting
  • Required 3 years of experience in managed care with knowledge of RAPS
  • Preferred Other 3 years supervisory experience
Candidate Skills:
  • Intermediate Ability to work in a fast paced environment with changing priorities
  • Intermediate Demonstrated customer service skills
  • Intermediate Ability to lead/manage others
  • Intermediate Ability to analyze and interpret financial data in order to coordinate the preparation of financial records
  • Intermediate Demonstrated interpersonal/verbal communication skills
  • Intermediate Demonstrated written communication skills
Licenses and Certifications:
A license in one of the following is required:
  • Required Certified Professional Coder (CPC)
Technical Skills:
  • Required Intermediate Microsoft Outlook
  • Required Intermediate Microsoft Excel
  • Required Intermediate Microsoft Word
  • Required Intermediate Microsoft PowerPoint
  • Required Intermediate Microsoft Visio

About us
Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at . EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.