Risk Adjustment (HCC Coding) Team Lead

The Risk Adjustment Team Lead will oversee day-to-day coding and abstraction operations, drive team productivity and quality, and ensure adherence to coding guidelines, regulatory requirements, and client commitments. The role requires strong risk adjustment expertise, hands-on operational involvement, team coaching, performance monitoring, and cross-functional collaboration to achieve production and quality targets.

• Monitor daily team productivity and ensure coding targets, quality standards, and turnaround times are met.
• Allocate and balance coding assignments based on project priorities, workload, and team capacity.
• Track individual and team performance, identify gaps, and implement corrective actions.

• Ensure accurate HCC coding in accordance with ICD-10-CM guidelines, risk adjustment requirements, and client standards.
• Review quality reports and over-read feedback to identify coding errors and drive continuous improvement.
• Support the resolution of complex coding cases and implement corrective action plans to improve accuracy.

• Coach and mentor coders to improve coding accuracy, productivity, and overall performance.
• Conduct refresher training, support new-hire onboarding, and address identified knowledge gaps.
• Promote accountability, engagement, and continuous learning within the team.

• Ensure adherence to coding guidelines, applicable regulatory requirements, HIPAA, and client-specific standards.
• Support coding audits and RADV activities, where applicable, and drive timely resolution of audit findings.
• Ensure compliance training and required coding assessments are completed on time.

• Monitor and report key metrics, including productivity, coding accuracy, quality scores, and turnaround times.
• Identify workflow inefficiencies and implement improvements to enhance coding quality and operational efficiency.
• Escalate coding, quality, and operational risks to Management with appropriate recommendations.

• Collaborate with Managers, QA teams, and other stakeholders to resolve coding issues and meet project objectives.
• Support coding guideline updates, system enhancements, and process changes, ensuring effective communication and implementation.

• Minimum of 6 years of medical coding experience, with strong expertise in Medicare Advantage and commercial risk adjustment, including HCC coding.
• Current coding certification through AAPC and/or AHIMA, such as CPC, CPC-P, CPC-H, CPC-I, CRC, CCS, RHIT, or RHIA.
• Prior experience as an SME, senior coder, quality reviewer, or team lead; supervisory or team management experience is strongly preferred.
• Strong knowledge of ICD-10-CM coding guidelines, HCC models, risk adjustment methodologies, medical terminology, anatomy, and pharmacology.
• Experience in HCC coding, coding quality reviews, over-read processes, and coding audit resolution.
• Demonstrated ability to meet productivity, coding accuracy, and quality targets.
• Proficiency in Microsoft Excel, coding platforms, and relevant healthcare applications.
• Excellent analytical, problem-solving, communication, and team management skills.
  

• Additional experience with Health Plan Risk Adjustment Data Validation (RADV) audits and audit readiness.
• Additional experience in facility coding, including OPPS/IPPS.