Risk Adjustment Medical Coder Team Leader

Job Description: Risk Adjustment Coding Team Leader

Job Summary

The Risk Adjustment Coding Team Leader is responsible for overseeing a dedicated team of Risk Adjustment (HCC) medical coders. This role ensures that daily operations run smoothly and that all client Service Level Agreements (SLAs), quality benchmarks, and productivity targets are consistently met or exceeded.

As a working supervisor, you will split your focus between direct team management, individual contributor development, process optimization, and occasional high-level auditing or clinical documentation validation.

Key Responsibilities

1. Leadership & Team Management

• Direct Supervision: Manage, mentor, and motivate a team of Risk Adjustment medical coders, fostering a collaborative and high-performance culture.
• Performance Monitoring: Conduct regular performance reviews, monitor daily output, and manage individual key performance indicators (KPIs) and quality scores.
• Coaching & Remediation: Provide continuous feedback, coaching, and targeted training for team members who require improvement or upskilling.
• Policy Enforcement: Ensure team adherence to company policies, operating standards, and compliance programs.

2. Operational Excellence & Quality Assurance

• SLA Delivery: Monitor queue volumes and manage workflows to ensure all turnaround times (TAT) and quality metrics are met for the client.
• Quality Audits: Perform periodic quality assurance checks and clinical documentation reviews to verify the accuracy of diagnostic code assignments (ICD-10-CM) and Hierarchical Condition Category (HCC) classifications.
• Escalation Management: Act as the primary point of contact for complex coding queries and clinical documentation discrepancies, resolving issues in consultation with the Operations/Program Manager.
• Process Improvement: Identify bottlenecks in current workflows and propose strategic changes to optimize productivity and database accuracy.

3. Documentation & Compliance

• Compliance: Keep the team updated on annual CMS risk adjustment updates, official ICD-10-CM coding guidelines, and HIPAA regulations.
• Record Keeping: Maintain precise records of team performance, training logs, audit findings, and client feedback.

Required Qualifications

Professional Licenses & Certifications (Mandatory)

• PHRN: Must possess an active and unrestricted Philippine Registered Nurse license.
• CPC (RA Coder): Must hold an active Certified Professional Coder (CPC) credential with specialized experience as a Risk Adjustment Coder (CRC is also highly preferred).

Experience

• At least 2–3 years of Risk Adjustment Coding experience, preferably with Subject Matter Expert (SME) or people-manager experience.
• At least 2 years of recent, pertinent clinical experience as a nurse.

Technical & Soft Skills

• Technical Skills: Deep familiarity with medical terminology, anatomy, physiology, and pathology, along with strong proficiency in Microsoft Office applications (Word, Excel, PowerPoint).
• Communication: Exceptional verbal, written, and interpersonal communication skills, with the ability to explain complex clinical and coding concepts clearly.

Work Flexibility & Attributes

• Shift Flexibility: Highly flexible and willing to work on a shifting schedule as business demands require (including weekends, night shifts, and holidays).
• Highly organized with strong multitasking, planning, and prioritization capabilities.
• Analytical mindset with keen attention to detail.
• Proven ability to take decisive, positive action to deliver immediate client value.