[Hiring] Supervisor, Risk Adjustment Quality Assurance and Auditing @Excellus BCBS

Role Description

The Supervisor, Risk Adjustment Quality Assurance and Auditing, is responsible for oversight of the daily operations of the Risk Adjustment Quality Assurance Auditor team. This role ensures the accuracy, compliance, and quality of the risk adjustment coding and documentation audits in alignment with regulatory requirements and organizational policies. This position provides leadership, training, and performance management to audit staff while driving continuous improvement in audit processes, coding accuracy, and operational efficiencies.

• Provide strategic oversight, supervision, and support to a team of Risk Adjustment Quality Assurance Auditors, ensuring all audit activities strictly adhere to state, federal, and corporate standards.
• Direct and coordinate the day‑to‑day operations of the Risk Adjustment QA Audit team, ensuring coding accuracy, regulatory compliance, and consistent application of CMS, ICD‑10‑CM, and organizational guidelines.
• Oversee risk adjustment audit activity including monthly internal coding quality audits and all federal and state risk adjustment data validation audits.
• Document and define audit project expectations and parameters for the Risk Adjustment Quality Assurance Auditors in keeping with deadlines.
• Assist in identifying areas of opportunity for external business partners and internal coding and audit staff for coding and audit education.
• Provide coaching, mentoring, and ongoing training to audit staff to enhance coding knowledge and audit performance.
• Ensure audits are conducted in accordance with CMS guidelines, ICD10-CM Official Coding Guidelines, risk adjustment coding standards, and organizational policies.
• Monitor audit quality, accuracy rates, and turnaround times.
• Serve as a subject matter expert for Risk Adjustment Audit and Coding.
• Evaluate day-to-day workload and processes to maximize productivity and efficiency.
• Develop corrective action plans, training material, and perform training as needed.
• Function as a backup quality assurance auditor for risk adjustment audit functions.
• Identify and recommend the development of new processes as necessary.
• Coordinate and perform all RADV audits and other audits as requested.
• Keep management informed of project activities through regular written and oral status reports.
• Consistently demonstrate high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values.
• Maintain high regard for member privacy in accordance with corporate privacy policies and procedures.
• Conduct regular staff meetings to include timely distribution and education related to departmental and Ethics/Compliance information.
• Perform other functions as assigned by management.

Qualifications

• Five (5) years ICD-10-CM and Hierarchical Condition Category (HCC) coding experience required.
• Prior experience supervising or managing people and/or projects or indirectly leading teams.
• Associate’s degree in a health care related field preferred.
• CPC and CRC certifications required.
• Other current coding certification (CPC-H, CPC-I, CCS, RHIA, or RHIT) preferred by AAPC or AHIMA.
• Certified Documentation Expert Outpatient (CDEO) preferred.
• Advanced knowledge of medical terminology, abbreviations, anatomy and physiology, major disease processes, and pharmacology.
• Extensive knowledge of coding conventions and payment rules as they apply to medical record documentation.
• Possess extensive knowledge of CMS and HHS HCC Risk Adjustment coding, Medicaid CRG coding, and data validation requirements.
• Strong written and verbal communication skills; strong analytical, organization and time management skills required.
• Recognizes and properly oversees confidential health information.
• Demonstrated ability to utilize a variety of Electronic Medical Records (EMR) systems.
• Demonstrated experience in project completion, educational program development, and/or group presentation.

Requirements

• Ability to work prolonged periods sitting and/or standing at a workstation and working on a computer.
• Ability to work in a home office for continuous periods of time for business continuity.
• Ability to travel across the Health Plan service region for meetings and/or trainings as needed.
• Repetitive motion required.

Benefits

• Compensation Range: Minimum $71,880 - Maximum $129,384.
• Participation in group health and/or dental insurance.
• Retirement plan.
• Wellness program.
• Paid time away from work.
• Paid holidays.