HCC & CPT Risk Coding and Compliance Manager

The Manager of Risk Coding and Compliance (HCC & CPT Coding and Auditing) is responsible for overseeing the development and execution of risk adjustment coding education, compliance initiatives, and clinical documentation improvement strategies. The manager will collaborate with providers, coding teams, and leadership to drive performance improvement, mitigate compliance risks, and enhance coding accuracy.

The position reports to the Director of Clinical Quality and Transformation. 

The role requires a mix of remote work and 25% - 50% travel to physician practices throughout New Jersey.

Salary range: $110,000 - $120,000 annually

Leadership & Compliance Oversight

• Develop and implement a comprehensive HCC and CPT coding compliance strategy to align with CMS regulations and industry best practices.
• Lead the risk coding team, ensuring all coding practices adhere to regulatory requirements and organizational policies.
• Monitor and interpret CMS updates, translating policy changes into actionable education and compliance initiatives.
• Serve as the primary liaison between coding, compliance, and clinical teams to enhance risk adjustment performance.

Education & Training Program Management

• Develop and deliver comprehensive HCC and CPT coding training programs for physicians, nurses, and other healthcare staff, covering topics like ICD-10 coding guidelines, HCC and CPT coding logic, and documentation requirements for accurate risk adjustment. 
• Conduct in-person and virtual training sessions, workshops, and webinars to educate providers on the impact of coding on risk scores and reimbursement. 
• Create educational materials like presentations, handouts, and online modules to support coding knowledge and understanding.

Compliance Monitoring:

• Oversee regular medical record reviews and audits to validate coding accuracy and compliance with CMS guidelines.
• Analyze audit results to identify trends and develop targeted educational interventions for providers. 
• Partner with physicians and clinical leadership to improve documentation practices, providing feedback and education on necessary documentation enhancements.

Policy and Guideline Updates:

• Stay current with CMS updates and changes to HCC and CPT coding guidelines to ensure training materials and compliance practices are aligned with the latest regulations. 
• Communicate new coding policies and updates to healthcare providers and coding staff. 

Required Skills & Qualifications:

• Experience leading a team, managing coding compliance programs, and collaborating with cross-functional teams.
• Minimum 3 years of experience in risk adjustment coding, preferably in a CIN, ACO, or value-based care setting.
• Strong knowledge of CMS-HCC, HHS-HCC, and ICD-10 coding guidelines.
• Experience in provider education, training, or clinical documentation improvement (CDI) is highly preferred.
• Excellent communication and interpersonal skills, with the ability to engage and educate diverse provider audiences.
• Proficiency in EMR/EHR systems and risk adjustment analytics tools.
• Willingness to travel throughout New Jersey (up to 25%- 50% travel required).
• Coding Certification - CPC, CRC, CCS-P, CCA, RHIT or RHIA- Required

EEOC Statement: Vanguard Health Solutions is an Equal Opportunity Employer. We are committed to creating a diverse and inclusive environment and are proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

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