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Manager, Coding Audits and ComplianceMass General Brigham Health Plan • Somerville, Massachusetts, United States
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Manager, Coding Audits and Compliance

Mass General Brigham Health Plan
  • US
    Somerville, Massachusetts, United States
  • US
    Somerville, Massachusetts, United States
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À propos

Oversees the coding audit and compliance aspects of risk adjustment processes. In partnership with key stakeholders, the role supports the management of oversight of offshore vendors and continuously works to improve people, processes, and technology across the function. The Risk Coding Audit team works to manage accurate and compliant coding practices, find opportunities for documentation improvement, optimize risk adjustment processes, and support revenue cycle management. The position applies knowledge of key business drivers and the factors that improve the Risk Adjustment departmental performance and anticipates business and regulatory issues and trends to identify improvements.
Essential Functions
Oversee daily risk coding audit operations to ensure compliance with regulations and standards.
Provide leadership and guidance to the coding audit team, ensuring proper training and adherence to coding guidelines.
Establish KPIs for risk coding functions; ensure the implementation of action plans when performance does not meet expectations.
Conduct audits and reviews of coding practices to identify and address discrepancies.
Lead end-to-end RADV efforts, coordinating cross‑functional teams, managing audit preparation and submissions, and ensuring timely and compliant responses to CMS and external auditors.
Implement and monitor risk mitigation strategies related to coding practices.
Provide direction and oversight across MGB's Risk Coding methodology, performance, and workflows.
Stay updated on changes in coding regulations and communicate these changes to the team.
Develop and enforce policies and procedures to maintain coding accuracy and integrity.
Prepare and present reports on coding performance and risk areas to senior management.
Oversee vendor management and proper compliance with internal and external required procedures.
Education
Bachelor's Degree (Health Information Management, Nursing, or another related field of study) required; experience can be considered in lieu of a degree.
Licenses and Credentials
Certified Risk Adjustment Coder (CRC) – Required within 6 months of start date.
Certified Professional Coder (CPC) – Preferred.
Certified Coding Specialist (CCS) – Preferred.
Experience
At least 5‑7 years of experience in medical coding, risk coding, or RADV audits required.
At least 1‑2 years of experience in a management or supervisory role required.
Knowledge, Skills, and Abilities
In-depth knowledge of coding standards, including ICD‑10, CPT, and HCPCS.
Strong leadership and team management skills.
Excellent attention to detail and analytical skills.
Proficiency in coding software and electronic health records (EHR) systems.
Effective communication skills, both written and verbal.
Ability to work collaboratively across departments to achieve organizational goals.
Strong problem‑solving abilities and the capacity to manage risk.
Commitment to continuous learning and staying informed on coding regulations.
Working Conditions
This is a remote role that can be done from most U.S. states.
Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.
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  • Somerville, Massachusetts, United States

Compétences linguistiques

  • English
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