Company Statement

For the last 80 years, EmblemHealth has been taking care of New York’s heart and soul, its people. Today, health care is more complex than ever. That’s why we’re at the forefront of change. We work alongside our customers to offer access to high-quality, affordable care, help navigate the health care experience, and make good health achievable; because everyone deserves to be taken care of. We deliver on our mission every day by living our values with our colleagues, members, clients and partners. It begins with caring and respecting all those we work with. We believe a culture of diversity and inclusion is vital to serve our unique and diverse customers. We seek for continues improvement and innovation and believe being agile and nimble is our advantage. We bring a strong sense of partnership to every relationship – internally and externally. The EmblemHealth family of companies offers competitive health, welfare, and retirement benefits as well as incentive pay plans and more.

Risk Adjustment Coding Director

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Director and Equivalent
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200YG Requisition #
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Lead the development and execution of an enterprise risk adjustment coding compliance function that will identify, assess and delete submitted diagnosis codes not in compliance with CMS submission requirements. Provide oversight of chart retrieval and coding vendor to execute the compliance program. Develop and implement strategy and actionable plans to take over the coding compliance function; build the capability and coding team to assume these functions internally. Serve as the enterprise government submission compliance subject matter expert. Assist in other initiatives and projects as needed.
 

 

Responsibilities: 

·       Lead the development and execution of EmblemHealth’s Enterprise Risk Adjustment Coding Compliance program.

·       Identify, assess and delete submitted diagnosis codes not in compliance with CMS submission requirements.

·       Work with external vendors to ensure complete and accurate analysis of system codes.

·       Drive the transition of coding compliance from external vendors to an in-house function.

·       Identify and build an enterprise risk adjustment submission coding team to support the Risk Adjustment Coding Compliance Program.

·       Develop and conduct coding education sessions with provider community to improve risk adjustment coding submissions and compliance.

·       Monitor, analyze and prepare reporting of coding compliance results overall and by provider.

·       Regularly meet with the provider community to share results of specific coding compliance activities.

·       Ensure that appropriate corrective actions are taken to maintain compliance.

·       Maintain industry coding knowledge, certifications and enterprise wide CMS coding compliance SME

·       Assist in other initiatives and projects as needed.

 


 

Qualifications:

·       BS in business administration or related healthcare field

·       Required certifications: Risk Adjustment Coder (CRC); Professional Coder (CPC)

·       Preferred certifications: Evaluation Management Coder (CEMC); Professional Medical Auditor (CPMA)

·       10+ years of related work experience in positions of increasing responsibility

·       Experience with leading a compliance related function across a large division, department, or company

·       Self-starter with ability to work with multiple levels of management and handle multiple tasks successfully

·       Prior experience working with external vendors

·       Proven track record of collaboration and coordination across all levels of provider organizations

·       Proven track record of collaboration and coordination across an entire enterprise or large division

·       Effective communications skills (verbal and written) with all types and levels of audiences.

·       Proficiency with MS Office applications (word processing, spreadsheet/database, presentation)

·       Energetic and enthusiastic with a positive attitude  

·       Knowledge of healthcare operational processes and products

EEOC Statement

We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.

Sponsorship Statement

Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, EmblemHealth may provide work visa sponsorship for certain positions.

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