Manager, Coding Audits and Compliance

Site: Mass General Brigham Health Plan Holding Company, Inc. Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham. Job Summary Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are at the forefront of transformation with one of the world’s leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage. Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills. We are pleased to offer competitive salaries and a benefits package with flexible work options, career growth opportunities, and much more. 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. -Establishes KPIs for risk coding functions; ensures 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. -Provides 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

Qualifications

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. Additional Job Details (if applicable) Working Conditions This is a remote role that can be done from most US states Remote Type Remote Work Location 399 Revolution Drive Scheduled Weekly Hours 40 Employee Type Regular Work Shift Day (United States of America) Pay Range $99,465.60 - $141,804.00/Annual Grade 8 At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package. EEO Statement: 8925 Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. 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. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642. Mass General Brigham Competency Framework At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.