Supervisor, Risk Adjustment & Quality

We believe that Wellvana is the catalyst for systemic change that reimagines and simplifies healthcare, making it easier to practice, access, and navigate for both the patient and physician.

We do this by partnering with practices to reduce administrative complexities and costs while offering individualized data-driven patient care focused on patient health rather than reacting to illness. The result is a system that empowers physicians to do what they love, helping patients, and in turn helps people lead healthier and happier lives.

Wellvana is one of the fastest growing healthcare companies in 2022. We are founded by Martin Ventures and led by market disrupting leaders who have created and led innovative companies such as Vanguard Health, SmileDirectClub, OrNda HealthCorp, Health Trust, HCA - And we’re doing it again. But this time, you can be a part of it.

We're looking for a Supervisor of Risk Adjustment & Quality to oversee and improve processes and to serve as our subject matter expert to the internal team and external clients.

What You'll do:

• Perform audits, coding, and provider education as per business needs
• Collaborates across the company and with vendors to help ensure the integration and alignment of risk adjustment strategies
• Interprets and provides feedback on CMS regulations and HCC risk adjustments reimbursement methodology
• Oversees claims/encounter data collection, processing, submission, and data reconciliation efforts with provider network and health plans ensuring that collected data is processed all the way to CMS’s supplemental submission system as well as EDPS system
• Present quality performance results and findings regularly, including the overall measure performance, improvement strategies, and tactics.
• Review of provider office/entity process for appropriate submission of ICD10, CPT, and HCPCS codes according to government and coding guidelines.
• Oversee and improve the various quality and risk adjustment processes.
• Assist client with the development of a comprehensive Risk Adjustment and Quality strategy and work plan, including workflow, outcome measures, and performance evaluation.
• Lead Physician educational campaigns.
• 25% Travel required
• Facilitate the development of key quality and risk adjustment key performance indicators.
• Recommend and/or implements process improvements related to the potential of quality medical care and service.
• Leads staff assigned to risk adjustment; provides guidance and engagement of staff; and builds effective teams (both internally and with vendors) to achieve established goals and within established budgets
• Ensures dissemination of clinical/reimbursement information to all key stakeholders
• Implements strategic and tactical improvements to the Risk Adjustment Coding and Quality/HEDIS processes.
• Support activities of the PCV (Preventative Care Visit) and patient outreach
• Serve as a quality and risk adjustment subject matter expert for internal and external clients.
• Perform other duties as assigned.
• Serves as a resource regarding government and regulatory audits, accreditation standards, and continuous quality improvement principles.
• Actively seeks and identifies opportunities for improvement.

• Minimum of 5 years’ experience in HCC-specific coding/auditing.
• 4+ years of experience in provider education
• Experience auditing physicians and coders.
• Experience working with ACO/ Health Plan
• Proficient in Word, Excel, and Outlook.
• Either CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist-Physician) and CRC (Certified Risk Adjustment Coder)
• Bachelor’s degree in health-related field preferred
• Experience in physician documentation/coding education. Experience in educating/training coders. ICD-10-CM Coding knowledge.
• Excellent communication, presentation, and analytical skills.
• Thorough understanding of Risk Adjustment, HCC coding, ICD coding, and RADV requirements.
• Knowledge of Medicare Advantage and other HCC entity program coding requirements.
• Experience in a broad range of HCC-related audit types and/or projects.