Risk Adjustment Manager - Summit Corporate Office

Overview

About Summit Medical Group

Summit Medical Group is East Tennessee’s largest primary care organization with more than 375 providers at 82 practice locations in 16 counties. Summit also consists of four diagnostic centers, mobile diagnostic services, eight physical therapy centers, four express clinics, central laboratory, and sleep services center. Summit provides healthcare services to more than 280,000 patients, averaging over one million encounters annually. For more information, visit www.summitmedical.com 

In addition to our commitment to the health of our community, our organization is also committed to the health of our employees through our employee Wellness Program.  Employees receive a discounted monthly insurance premium if they actively participate in the wellness program. Furthermore, Summit Medical Group hires only non-tobacco users. Pre-employment drug testing will include testing for nicotine, and only candidates who pass the drug test will be considered eligible for employment.

Responsibilities

About Our Career Opportunity

Summit Medical Group is seeking a Risk Adjustment Manager to join their team. This is a Full time opportunity, working Monday - Friday 8:00a.m. - 5:00p.m. This is an on-site position with potential to work from home after six months. 

Responsibilities: (List does not include all duties assigned)

Examples of Duties (List does not include all duties assigned)1) Assess and develop necessary training and quality needs for the Risk Coding team.2) Works directly with Director of Risk Coding to provide necessary provider materials.3) Works directly with health plans and external partners as appropriate to complete the risk adjustment activities necessary to meet the SMG mission and goals.

4) Responsible for creation of presentations and reports related to risk adjustment activities and outcomes.5) Build and support a team environment that promotes the values of Summit Medical Group and focuses on positive outcomes to meet and exceed contractual and organizational goals.6) Monitors reports for productivity and staff feedback.7) Works with management to develop policies / procedures as needed.8) Remains current on medical coding and billing guidelines and auditing protocols.9) Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelines.10) Performs miscellaneous job-related duties as assigned.11) Participates in testing and training as required by the Company.12) Travel to sites may be required based on project to project need.13) Actively participates in site-level Quality Improvement Activities. Each employee will contribute to the continual evaluation site performance as well as the implementation and measurement of improvement activities that increase the quality of care provided to patients.14) Performs other duties as assigned

Qualifications

Education: Minimum of 2 year’s post high school education or degree from a 2-year college. RHIT undergraduate degree preferred.

Experience: At least three years’ experience in in ICD-10, CPT, HCPCS, HEDIS and Risk Adjustment Experience. Certification as a CCS, CCS-P, CPC, CPC-H, CRN-C, RHIT, or RHIA preferred. Extensive knowledge of medical billing and payment methodologies, including all coding guidelines for ICD-10 and evaluation and management coding required. Demonstrated understanding of CMS HCC Risk Adjustment coding and data validation requirements required.

Previous management or leadership experience preferred.