Boston Medical Center (BMC) · 3 weeks ago
Manager, Risk Adjustment Coding
United States
Full-time
Remote
Mid, Senior Level
$72K/yr - $105K/yr
4+ years expBoston Medical Center (BMC) is seeking a Manager of Risk Adjustment Coding to oversee the day-to-day operations of the Risk Adjustment Coding Team. This role involves managing workflows for auditing electronic medical records and ensuring compliance with coding practices to improve patient care and reduce healthcare costs.
Health CareHospitalMedicalNon Profit
Responsibilities
In partnership with key stakeholders, supports management of oversight of Coders and continuously works to improve people, process, and technology across the function
Works in partnership with Value Based Care Team to manage accurate and compliant coding practices, find opportunities for documentation improvement, optimize risk adjustment processes, and support revenue cycle management
Applies knowledge of key business drivers and the factors that improve the Risk Score Management departmental performance and anticipates business and regulatory issues and trends to identify improvements
Actively contributes to the strategic direction for Risk Coding and collaborates with internal and external partners to lead volume and ensure adherence to agree upon SLAs
Communicates relevant changes in performance, market trends, health care delivery systems, and legislative initiatives impacting execution of team goals to team(s)
Establishes KPIs for Risk Coding functions; ensures the implementation of action plans where performance is not meeting expectations
Maintains current knowledge of regulatory and compliance changes impacting Risk Coding operations, and ensures all employees are appropriately educated
Provides guidance and oversight for Risk Coding methodology, performance, and workflows
Identifies and solves complex, operational, or cross-functional problems using the appropriate resources within or outside the department
Facilitates projects and conversations within BMCHS to share and develop standard processes
Develop and implement quality improvement initiatives, examples include; conducting regular audits, educating coders/clinicians, and monitoring KPIs for improvements
Ensure compliance with all applicable Federal, State and/or County laws and regulations related to coding and documentation guidelines for Risk Adjustment
Conduct reviews for clinical indicators and query providers to capture the severity of illness of the patient
Measure Providers’ performance on important aspects of care and service
Facilitates and coordinates reporting to leadership within the organization as requested
Provides clear, concise and professional communication to varying audiences depending on the project and its goals
Supports the RA Team in a positive manner with emphasis on providing excellent service to all patients, providers, internal and external customers
Communicates to Manager and IT Department regarding defects identified in the reporting systems or data base, suggests performance improvement opportunities and tracks through completion to insure revenue capture
Demonstrates excellent time management, attends and contributes to required meetings
Demonstrates the ability to train new staff or provide ongoing education and training to existing staff along with regularly performing quality reviews and including feedback on opportunities for improvement to the Risk Coding team
Additional duties as required
Must adhere to all of BMC’s RESPECT behavioral standards
Qualification
Required
Associates Degree Required
Coding Certification from American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA) is required
Certification may include Certified Risk Adjustment Coder (CRC) or Certified Professional Coder (CPC) and/or Certified Clinical Documentation Specialist- Outpatient or Certified Documentation Expert Outpatient (CDEO) Certified Coding Specialist (CCS), or Certified Coding Specialist Physician-Based (CCS-P), or a Certified Coding Associate (CCA), or Risk Adjustment Coder (RAC), or Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA) required
Minimum of four (4) years progressive coding and/or coding leadership experience in Risk Adjustment Coding
Willing to work as a team – innovation and collaboration is a priority
Knowledge of AHA coding guidelines and methodologies: HCC's and other RA methodologies, ICD-10-CM coding guidelines, Office of Inspector General (OIG) and Federal and State regulations
Extensive knowledge of medical terminology, anatomy, and pathophysiology, pharmacology, and ancillary test results
Strong organization and analytical thinking skills – detail oriented
Proficient with Microsoft Office applications (Outlook, Word, Excel)
Demonstrates critical thinking skills, able to assess, evaluate, and teach
Self-motivated and able to work independently without close supervision
Strong communication skills (interpersonal, verbal and written)
Medical Record audits and review
Familiarity with the external reporting aspects of healthcare
Familiarity with the business aspects of healthcare, including prospective payment systems
Proficient with computer applications (MS Office etc.), Excellent data entry skills
Strong knowledge of health records, computerized billing and charging systems, Microsoft applications, data integrity, and processing techniques required
Excellent organizational skills, including ability to multi-task, prioritize essential tasks, follow-through and meet timelines
Ability to work with accuracy and attention to detail
Ability to solve problems appropriately using job knowledge and current policies/procedures
Ability to work cooperatively with members of the healthcare delivery team and staff, ability to handle frequent interruptions and adapt to changes in workload and work schedule and to respond quickly to urgent requests
Must be able to maintain strict confidentiality of all personal/health sensitive information and ensure compliance of HIPAA rules and regulations
Preferred
Bachelor's Degree Preferred
Experience with an Electronic Medical Record (EMR), EPIC preferred
Benefits
Medical
Dental
Vision
Pharmacy
Discretionary annual bonuses
Merit increases
Flexible Spending Accounts
403(b) savings matches
Paid time off
Career advancement opportunities
Resources to support employee and family well-being
Company
Boston Medical Center (BMC)
Boston Medical Center (BMC) is a 511-bed, equity-led academic medical center and a proud member of the Boston Medical Center Health System.
5001-10000 employees
H1B Sponsorship
Boston Medical Center (BMC) has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (53)
2024 (51)
2023 (51)
2022 (38)
2021 (26)
2020 (32)
Funding
Current Stage
Late StageTotal Funding
$342.49MKey Investors
AmeriCorps Public AlliesNational Institute on Drug Abuse (NIDA)The Boston Foundation
2024-07-09Grant· $0.06M
2023-02-23Debt Financing· $232M
2019-04-23Grant· $89M
Leadership Team
David Beck
Senior Vice President & Chief Legal Counsel
Recent News
2025-11-11
2025-11-10
Company data provided by crunchbase