Risk Adjustment Coding Quality Assurance Manager

Homeward is rearchitecting the delivery of health and care in partnership with communities everywhere, 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 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. Homeward supports Medicare-eligible beneficiaries by partnering with health plans, providers, and communities to align incentives – taking full financial accountability for clinical outcomes and the total cost of care across rural counties.

As a public benefit corporation and Certified B Corp™, Homeward’s mission and business model are aligned to address the healthcare, economic, and demographic challenges that make it challenging for rural Americans to stay healthy. Our Homeward Navigation™ platform uses advanced analytics to connect members to the right care and local resources that address social determinants of health and improve holistic health outcomes. Since many rural communities lack adequate clinical capacity, Homeward also employs care teams that supplement local practices and reach people who cannot otherwise access care.

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.

The Opportunity

Join us in tackling healthcare for rural America! We’re seeking a Risk Adjustment Coding Quality Assurance Manager 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 Risk Adjustment Quality Assurance Manager plays a critical role in ensuring the accuracy and compliance of Medicare Advantage risk adjustment coding processes. You will oversee quality assurance for risk adjustment coding & documentation special projects, utilizing a variety of different coding platforms. This role aims to improve the accuracy of diagnosis coding, directly affecting the quality of care and appropriate reimbursement.

What You'll Do:

Operational Leadership & Accountability:
Oversee and guide a team of risk adjustment coders to consistently meet or exceed established project metrics, taking full ownership of project outcomes and deliverables.
Auditing and Feedback:
Conduct regular audits of medical records, coding, and documentation to identify areas of improvement. This role has a strong focus on Second-Level Reviews and QA (Quality Assurance).
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.
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 full adherence to regulatory requirements, including those set by Medicare, Medicaid, and CMS. Provide clear guidance to prevent fraud, waste, and abuse in coding and documentation practices.
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.
Special Projects:
This role will continue to evolve and grow as Homeward launches additional Coding Support products, which can include, but is not limited to HEDIS, Medicaid, Commercial reviews, and Pre-Visit Analysis Support.

What You Bring:

• Strict adherence to CMS and OIG risk adjustment guidelines, maintaining the highest standards of regulatory compliance and integrity
• 5 years of experience in medical coding, healthcare education, or a related field, with a strong focus on Medicare Advantage risk adjustment.
• Certified Risk Adjustment Coder (CRC) certification
• In-depth knowledge of Medicare Advantage risk adjustment methodology and coding guidelines
• Strong understanding of ICD-10-CM diagnosis coding
• Excellent communication skills
• Familiarity with risk adjustment retrospective chart review coding processes and technology
• Familiarity with electronic health record (EHR) systems
• Knowledge of healthcare compliance, regulations, and billing practices
• Analytical and problem-solving skills

Bonus Points:

• Additional AAPC or AHIMA certification (RHIA, RHIT, CDIP, etc.)
• Experience with risk adjustment technology solutions and risk adjustment retrospective chart review vendors.
• Previous experience building from the ground up on a small, fast-paced team.

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!

Benefits:

• 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

The base salary range for this position is $110,000 to $125,000 annually. Compensation may vary outside of this range depending on a number of factors, including a candidate’s qualifications, skills, location, competencies, and experience. Base pay is one part of the Total Package that is provided to compensate and recognize employees for their work at Homeward Health. This role is eligible for an annual bonus, stock options, and a comprehensive benefits package.

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.