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Manager, Risk Adjustment Operations
Clinical Operations
Full Time

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Title/Position: Manager, Risk Adjustment 

Department or Business Unit: Value-Based Care, Quality

Reporting Structure: Director, Quality

Employment Type: FTE

Exemption Status: EXEMPT

Min. Experience: MID-Level

Travel Required: Yes 25%

Overview of the Role:

The Manager, Risk Adjustment Operations is responsible for overseeing Privia Health’s national Risk Adjustment (RA) capabilities, including Training & Education, Concurrent Coding, and any other operational capabilities. The Manager will be directly responsible for providing leadership, planning and guidance to market Risk Adjustment Educators. Readily ensures communication, education and program process improvement is documented and achieved. They will work closely with all markets to build operational action plans and execute to goals, integrating with other relevant teams, such as Population Health, Analytics, and Performance.

Primary Job Duties: 

  • Act as the internal subject matter expert and escalation point for Risk Adjustment capabilities for Market Teams and providers 
  • Manage team of in-market Risk Adjustment Educators
  • Ensure HCC Concurrent Coding and Training programs are operating effectively and efficiently
  • Develop centralized training programs, such as webinars, recorded trainings, and/or training materials to support providers in risk adjustment
  • Implement risk adjustment programs in new markets as needed
  • Manage and triage Risk Adjustment (RA) provider emails 
  • Review and sign-off on all third party developed guidelines 
  • Work effectively with physicians, Non-physician practitioners (NPP), practice staff, health plan/other external parties and Privia multidisciplinary teams
  • Collaborate with the Population Health, Analytics and Performance teams to resolve issues and answer questions in a timely manner
  • Work with Analytics to understand performance at a National, Market, physician practice, and provider level to identify opportunities for improvement
  • Support RA Educators with ad hoc provider risk adjustment audits
  • Accurately follow documentation and coding guidelines and legal requirements to ensure compliance with federal and state regulatory bodies
  • Perform other related duties, which may be inclusive, but not listed in the job description

Minimum Qualifications:

  • Previous experience with Risk Adjustment training
  • Previous experience with Coding (ICD-10-CM)
  • Knowledge of Federal laws and regulations, including NCDs and LCDs affecting risk adjustment documentation and coding compliance
  • Extensive knowledge of documentation and coding guidelines established by the Center for Medicare and Medicaid Services (CMS) and the American Medical Association (AMA) for assignment of diagnostic and procedural codes
  • Knowledge of Health care insurance claims practice and compliance
  • Certified Professional Coder (CPC) , Certified Risk Adjustment Coder (CRC) preferred 
  • Experience with MS Office Suite, Electronic Medical Records, Encoder, Coding Clinic, Customer Relationship Management (CRM) or other software programs and internet based applications as needed
  • Maintain patient, team member and employer confidentiality; comply with all HIPAA regulations  

Interpersonal Skills & Attributes:

  • Able to have honest, difficult conversations with providers about diagnosis documentation and code assignment
  • Ability to communicate effectively, verbally and in writing
  • Establish and maintain effective working relationships with providers, management, clients and staff
  • Excellent interpersonal and presentation skills 
  • Express ideas clearly and effectively
  • Respond calmly and maturely in high pressure situations
  • Keep a positive attitude toward company, work, clients, management, and team members
  • Use a customer focused approach in dealing with conflict and resolution of problems

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus.  

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