Lead Risk Adjustment Coding Specialist (Hybrid)
Homeward is a technology-enabled healthcare provider delivering quality, affordable and comprehensive care to those who don’t have it. Starting in rural America. Today, 60 million Americans living in rural communities are facing a crisis of access to care. In the U.S. healthcare system, rural Americans experience significantly poorer clinical outcomes. This trend is rapidly accelerating as rural hospitals close and physician shortages increase, exacerbating health disparities. In fact, Americans living in rural communities suffer a mortality rate 23 percent higher than those in urban communities, in part because of the lack of access to quality care.
Our vision is care that enables everyone to achieve their best health. So, we’re rearchitecting the way it’s delivered – leveraging breakthroughs in diagnostics, remote monitoring, and a variety of other domains, Homeward is creating a new healthcare delivery model that is purpose-built for rural America and directly addresses the issues that have historically limited access and quality.
Most importantly, we’re aligning everyone’s incentives (ours, partner health plans’, and members’) towards getting and keeping people healthy by taking full responsibility and financial risk for the total cost of each member’s healthcare and outcomes.
Homeward is co-founded by a leadership team that defined and delivered Livongo’s products, and backed most recently by a $50 million series B co-led by Arch Ventures and Human Capital, with participation from General Catalyst for a total of $70 million in funding. With this leadership team and funding, Homeward is committed to bringing high-quality healthcare to rural communities in need.
Join us in tackling healthcare for rural America! We’re seeking a Lead Risk Adjustment Coding Specialist who is passionate about having a positive societal impact and using technology for good – solving issues of health inequity for communities that have been perennially underserved.
The Lead Risk Adjustment Coding Specialist plays a critical role in ensuring the accuracy and compliance of Medicare risk adjustment coding processes. You will educate clinicians and support staff about proper coding and documentation practices specific to Medicare risk adjustment. This role aims to improve the accuracy of diagnosis coding, directly affecting the quality of care and appropriate reimbursement.
What You'll Do
- Educational Programs: Develop and deliver educational programs, workshops, and training sessions on coding and documentation guidelines
- Documentation Improvement: Collaborate with clinicians and support staff to identify opportunities for improving documentation to support accurate coding, risk adjustment, and compliance
- Coding Guidelines: Stay updated with the latest CMS (Centers for Medicare and Medicaid Services) risk adjustment guidelines and regulations to ensure education materials and training programs are current
- Auditing and Feedback: Conduct regular audits of medical records, coding, and documentation to identify areas of improvement. Provide feedback and coaching to clinicians to address deficiencies
- Coding Accuracy: Promote and maintain accurate and complete coding practices that reflect the severity and complexity of patients' conditions to optimize risk adjustment factors
- Compliance: Ensure adherence to all regulatory requirements, including Medicare and CMS guidelines, and provide guidance on avoiding fraud, waste, and abuse in coding and documentation
- Data Analytics: Analyze data related to coding accuracy, risk adjustment scores, and financial outcomes to identify areas for improvement and develop strategies to address them
- Training Materials: Develop and update educational materials, resources, and reference guides for healthcare professionals and coders
- Quality Improvement: Collaborate with quality improvement teams to integrate risk adjustment coding best practices into healthcare processes and improve the overall quality of care
- Communication: Communicate changes in risk adjustment coding policies and guidelines to staff, as well as assist in resolving coding-related issues
- Maintain databases of required licenses, certifications, in-network contract status, and credentials
- Manage Homeward’s provider roster to mitigate risks associated with growth, drive efficiency, and
advance proactive monitoring and action related to licensing, credentialing, and contracting
- Monitor and communicate status, plans, and barriers related to operational processes and
deliverables to stakeholders and drive solutions to overcome challenges
What You Bring
- 2+ years of licensing, credentialing, and contracting experience with a variety of provider types: MD,
DO, PA, RN, allied health providers, and behavioral health
- In-depth knowledge of regulations, requirements, and procedures related to Medicare licensing,
credentialing, and health plan contracting
- Experience with credentialing management system
- Highly detail-oriented: you routinely catch the little things that others miss or overlook
- Exceptional communication skills to support work with different groups of stakeholders and
communicate process and progress to the organization
- Experience with credentialing in a health technology organization
- Experience with Medicaid, Commercial, and ACA lines of business
- Experience with primary care credentialing
- Strong process and project management skills, including use of enabling tools and software
What Shapes Our Company
- Deep commitment to one another, the people and communities we serve, and to care that enables everyone to achieve their best health
- Compassion and empathy
- Curiosity and an eagerness to listen
- Drive to deliver high-quality experiences, clinical care, and cost-effectiveness
- Strong focus on the sustainability of our business and scalability of our services to maximize our reach and impact
- Nurturing a diverse workforce with a wide range of backgrounds, experiences, and points of view
- Taking our mission and business seriously, but not taking ourselves too seriously– having fun as we build!
- Competitive salary and equity grant
- Unlimited Paid Time Off
- Comprehensive benefits package including medical, dental & vision insurance with 100% of monthly premium covered for employees
- Company-sponsored 401k plan
- Flexible working arrangement
Salary range: $100,000 - $140,000 annually. Salary is based on qualifications, experience, skillset, and location.
At Homeward, a diverse set of backgrounds and experiences enrich our teams and allow us to achieve above and beyond our goals. If you have yet to gain experience in the areas detailed above, we hope you will share your unique background with us in your application and how it can be additive to our teams.
Homeward is an affirmative action and equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity, national origin, veteran status, or genetic information. Homeward is committed to providing access, equal opportunity, and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities.