Medical Director of Risk Adjustment and Coding

  • Heal
  • Remote
  • Mar 29, 2022
Physician

Job Description

Who We Are:

Heal is revolutionizing the healthcare experience by putting patients first. We provide tech enabled in-home primary care services for seniors, consisting of house calls, telemedicine and remote patient monitoring (RPM). We currently operate in New York, New Jersey, North Carolina, South Carolina, Georgia, Louisiana, Illinois, and Washington, with future plans for national expansion.

Since being founded in 2014, Heal has delivered over 250,000 house calls. We are proud to mention our very wide range of notable investors, including: Paul Jacobs, Humana, Jeb Bush, Breyer Capital, IRA Capital, Trans-Pacific Technology Fund, Lionel Richie, and more.  

The Role:

Heal is seeking a Medical Director of Risk Adjustment and Coding to oversee medical coding, clinical documentation integrity, quality, and revenue integrity programs for its affiliated medical practices. This individual will report directly to the Chief Medical Officer and will support Heal’s mission of transforming healthcare for seniors through technology-enabled, home-based primary care. The Medical Director of Risk Adjustment and Coding must have ample expertise operating in a value-based care environment, with excellent knowledge of coding guidelines, HCC payment models, and best practices in CDI, auditing, and coding. The ideal candidate will be a physician with a coding background who can assist in bridging the gap between coding and clinical medicine, including developing clinician training on coding/documentation, contributing to the design of our Heal EHR, and serving as a champion of coding/documentation. The individual will help establish system wide coding standards, policies and procedures related to charge capture, and professional coding and billing practices and will oversee a high qualified coding and CDI team.  

Job Responsibilities:

  • Optimize Heal’s mid-revenue cycle strategy in support of our mission:
    • Interpret data, financial metrics and provide reporting to executive leadership.
    • Work with leaders and IT to develop KPIs, performance dashboards, and reporting. 
    • Lead annual mid-revenue cycle strategic planning, strategy execution, and implementation of standardized processes and procedures to produce predictable high-quality financial outcomes. 
    • Partner with Chief Financial Officer, product team, engineering team, data science team, and external vendors to optimize revenue collection, both through direct input on revenue cycle management practices as well as changes to mid-revenue cycle implementation. 
  • Develop payer agnostic risk adjustment and HEDIS capture strategy.  
  • Develop coding, audit, and CDI practice standards, procedures, and policy with internal coders
    • Oversee and operationalize coding and CDI programs to drive best practices for complete and accurate documentation of patient health status and demonstrate the exceptional care those patients receive.
  • Lead education programs for clinicians on coding/documentation best practices 
  • Contribute to design of Heal EHR to support accurate and comprehensive documentation in accordance with best practices. 
  • Oversee compliance and appropriate audit programs for all coding quality and CDI activities
  • Oversee our process for medical staff query and follow up where appropriate
  • Develop, scale, and implement outpatient prospective and concurrent coding and CDI processes.
  • As needed, initiate, review, implement, and manage vendors for outsourced coding services. 
  • Assess potential and existing risks in regulatory and/or coding practices and answer questions and resolve coding, documentation and data quality compliance issues identified.

Qualifications: 

  • Must be a physician (foreign medical graduates welcomed).
  • Certified Professional Coder or Certified Risk Adjustment Coder (AAPC CPC/CRC or AHIMA CCS-P). 
  • 5+ years of experience in Medicare Advantage
  • 3+ years progressive leadership in an outpatient healthcare environment.
  • Excellent leader - experienced and track record in leading remote teams and demonstrates excellent people management skills. 
  • Thorough understanding of the relationship between codes and revenue in the reimbursement process, specifically how revenue is generated from ICD-10CM, CPT, and HCPCS codes.
  • Prior exposure to revenue cycle management and healthcare financial performance.
  • Expert in documentation and coding requirements for professional services.  
  • Expert knowledge of current coding guidelines and federal and state reimbursement program requirements, CMS Conditions of participation, MACs, NCCI edits.
  • Experience in researching complex coding compliance issues and questions.
  • Experience in developing effective education programs for adult learners (coders, clinicians, clinical staff).
  • Knowledge of business ethics and compliance risks and the ability to manage those risks in a dynamic health care environment.
  • Excellent written, verbal and group presentation skills. 
  • Excellent at MS Office Word, Power Point, Excel, and Outlook, or Google Suite of applications. 

Get Heal (dba “Heal”) recognizes and values the key to success is the experiences and perspectives of people from all walks of life. Heal is proud to be an equal employment opportunity employer to all individual, regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, or any other characteristic protected by state, federal, or local law.