Supervisor – Risk Adjustment

Department: Quality - Risk Adjustment

Employment Type: Full Time

Location: 19500 HWY 249, Suite 570 Houston, TX 77070

Reporting To: Mauriel Chaidez-Puentes

Compensation: $80,000 - $90,000 / year

Description

We are seeking an experienced and motivated Risk Adjustment Coding Supervisor to oversee and support a team of Risk Adjustment Coders. This role is responsible for supervising daily coding activities, ensuring accuracy and compliance with CMS Risk Adjustment guidelines, and supporting the Manager with day-to-day operations of the Risk Adjustment department.

The ideal candidate will value coaching staff and providers, and be highly data-driven, with the ability to analyze coding, audit, and performance data to identify trends, gaps, and opportunities. 

We are seeking candidates who have experience with provider education and who are comfortable traveling around Houston 75% of the time! 

Our Values: 

• Put Patients First
• Empower Entrepreneurial Provider and Care Teams
• Operate with Integrity & Excellence
• Be Innovative
• Work As One Team

What You'll Do

Team Leadership & Supervision

• Supervise, coach, and mentor Risk Adjustment Coding Specialists to ensure high-quality, compliant coding practices
• Serve as a resource for coders regarding ICD-10-CM, HCCs, CMS Risk Adjustment guidelines, and documentation standards
• Monitor individual and team productivity, accuracy, and quality metrics; provide ongoing feedback and corrective action as needed
• Utilize productivity, quality, and audit data to identify performance trends, coding gaps, and training opportunities
• Translate data insights into actionable feedback, performance improvement plans, and targeted education
• Assist with onboarding and training of new coding staff

Operational Support

• Support the Risk Adjustment Manager with day-to-day departmental operations, including workflow coordination, prioritization of audits, and issue resolution
• Assist in developing and maintaining standard operating procedures, workflows, and best practices
• Analyze Risk Adjustment data (e.g., recapture rates, audit findings, productivity, denial trends) to support departmental strategy and prioritization
• Collaborate with leadership to design and implement new or enhanced workflows for coders based on data, performance metrics, and operational needs
• Support reporting and dashboard development to track coding performance, quality outcomes, and Risk Adjustment impact
• Escalate operational, compliance, or performance issues to leadership as appropriate

Coding, Auditing & Compliance

• Review provider documentation and medical records to ensure all Medicare Advantage and Commercial Risk Adjustment requirements are met
• Perform and/or oversee retrospective and prospective medical record reviews to identify, assess, monitor, and document HCC coding opportunities
• Conduct coding quality audits to ensure ICD-10-CM codes are accurately assigned and supported by clinical documentation
• Analyze audit results to identify systemic coding or documentation trends and recommend process improvements
• Prepare audit analyses and provide feedback on noncompliance or documentation improvement opportunities

Provider & Staff Education

• Interact with physicians and provider office staff regarding coding, billing, and documentation policies and procedures
• Deliver education and training on Risk Adjustment and documentation improvement, both individually and in group settings
• Assist with the development of educational materials and presentations, including PowerPoint content
• Other duties as assigned

Qualifications

• Travel
  • Reliable transportation and valid driver’s license
  • Ability to travel up to 75% of the time within the designated markets, primarily Houston, with travel to Beaumont and San Antonio as needed. 
• Certifications
  • Certified Coding Specialist (CCS or CCS-P) OR Certified Professional Coder (CPC)
  • Certified Risk Adjustment Coder (CRC) (not required but highly preferred)
• Experience
  • Minimum of 4–5 years of medical coding experience, including Risk Adjustment and HCC coding
  • Prior lead, senior, or supervisory experience
• Skills & Abilities
  • Strong knowledge of Medicare Advantage Risk Adjustment and Hierarchical Condition Categories (HCC)
  • Strong data analysis skills with the ability to interpret coding, audit, and performance metrics