Director of Risk Adjustment
Company: Summit Medical Group, P.L.L.C
Posted on: February 25, 2021
Summit Medical Group 1275 Dick Lonas Road Suite 101 Knoxville,
TN 37909 Director of Risk Adjustment in Knoxville, Tennessee -
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in! Director of Risk Adjustment Job Locations US-TN-Knoxville ID
2021-1931 Site Name Summit Corp Office Category Risk Adjustment
Type Full-Time Overview About Summit Medical Group Summit Medical
Group is East Tennessee's largest primary care organization with
more than 300 providers at 66 practice locations in 15 counties.
Summit also consists of four diagnostic centers, mobile diagnostic
services, eight physical therapy centers, four express clinics,
central laboratory, extensivist clinic, and sleep services center.
Summit provides healthcare services to more than 280,000 patients,
averaging over one million encounters annually. For more
information, visit www.summitmedical.com In addition to our
commitment to the health of our community, our organization is also
committed to the health of our employees through our employee
Wellness Program. Employees receive a discounted monthly insurance
premium if they actively participate in the wellness program.
Furthermore, Summit Medical Group hires only non-tobacco users.
Pre-employment drug testing will include testing for nicotine, and
only candidates who pass the drug test will be considered eligible
for employment. Responsibilities About Our Career Opportunity As
Summit Medical Group in Knoxville, Tennessee continues to commit to
value based care based on measurable quality health outcomes, our
organization is seeking a Director of Risk Adjustment. The Director
of Risk Adjustment is responsible for day to day operations of
Coding Support and Pre-Visit Planning staff for Risk Adjustment
projects and other projects as deemed necessary by the Company.
This person will be the subject matter expert on risk coding for
the organization. This role requires residence in the Knoxville,
Tennessee area.-- Examples of Duties (List does not include all
- Fosters a culture for best practices sharing, peer service
orientation, measurement, accountability, and continuous
- Oversees the workflows for medical chart audits for both
retroactive and prospective basis to identify, and monitor
documentation as it relates to the Hierarchical Condition
- Review internal controls, policies and procedures to ensure
compliance with appropriate SMG, Stated and Federal guidelines and
- Oversees coding abstraction and medical chart quality audits to
ensure clinicians have accurate clinical documentation to support
ICD-10 codes and are adhering to CMS Risk Adjustment
- Provide clinician onboarding, annual and/or as needed education
on specific coding issues and opportunities found in their
- Ensures reimbursement is maximized through appropriate coding
via implementation of best practices and processes.
- Manages annual recoding efforts.
- Works directly with Decision Support to develop / enhance
reporting showing coding trends.
- Remains up to date with all industry coding and compliance
issues to act as the subject matter expert for the
- Engages health plans and government agencies.
- Collaborates with senior management to develop strategies and
tactics that improve the accuracy of risk scores and reduce payment
- Hires, trains, coaches, counsels, and evaluates performance of
- Performs other duties as assigned. Qualifications Education---
2 years' post high school education or a degree from a two-year
college. RHIT undergraduate degree prefer. Education may be waived
in lieu of experience. Experience-
- Clinical experience and experience with ICD 10 & CPT coding in
an ambulatory setting required.
- CMS HCC Risk Adjustment Coding experience required.
- Previous management experience required.
- Experience working with all lines of business (Medicare,
Medicaid, and Commercial). Certification/License--- Certification
as a CCS, CCS-P, CPC, CPC-H or CRN-C required.-- Active nursing
license preferred (Registered Nurse or Licensed Practical Nurse).
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Keywords: Summit Medical Group, P.L.L.C, Tuscaloosa , Director of Risk Adjustment, Executive , Knoxville, Alabama
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