Operations Supervisor, Risk Adjustment

Are you an experienced leader with a strong background in medical records coding and quality assurance? Risk Adjustment is looking for a Supervisor to lead a dynamic team dedicated to accuracy and compliance in risk adjustment coding.

About the Team:
This team plays a critical role in reviewing medical records, capturing conditions per established guidelines, and ensuring quality standards are met.

What You’ll Do:

• Assign and monitor coding and QA tasks, ensuring production and quality goals are achieved.
• Provide feedback, coaching, and support to team members.
• Manage day-to-day operations, including PTO approvals and resolving workflow challenges.
• Act as the go-to resource for troubleshooting issues, whether technical or process-related.

 

Ideal Candidate Preferences:

• Familiarity with ICD-10 coding and risk adjustment processes.
• Prior experience managing direct reports and handling complex situations with tact.
• Ability to adapt quickly to changing circumstances. This is crucial for interpreting unique medical records, resolving tech issues, or coaching staff through performance challenges.

This is an opportunity to lead a high impact team and make a difference in healthcare quality and compliance. If you’re ready to take on a leadership role where your expertise and guidance matter, we’d love to hear from you!

Job Responsibilities

• Directly supervise 1st pass review of medical records and physician assessment forms (PAFs).
• Perform or participate in special projects as directed by management.
• Oversee the acquisition of medical records from provider offices and supervise the medical record quality review process.
• Ensure team compliance with CMS risk adjustment diagnosis coding guidelines.

Job Qualifications

Education

• Associates degree in related healthcare field or equivalent years of experience. Equivalent years of experience are defined as one year of professional experience for every year of college requested.

Experience

• 2 years - Management and/or leadership experience required
• 3 years - Progressive medical coding and health care experience required.

Skills\Certifications

• Professional coding certification from AHIMA or AAPC (CPC, CCS, CRC, RHIT, RHIA).
• Must acquire the Certified Risk Adjustment Coder (CRC) certificate from AAPC within the first year of employment.  
• Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability.
• Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)
• Proven analytical and problem solving skills and ability to perform non-routine analytical tasks
• Must be a team player, be organized and have the ability to handle multiple projects
• Excellent oral and written communication skills
• Strong interpersonal and organizational skills
• Knowledge of CMS guidelines required.
• Understanding of ICD-10 coding standards required.

Number of Openings Available

1

Worker Type:

Employee

Company:

BCBST BlueCross BlueShield of Tennessee, Inc.

Applying for this job indicates your acknowledgement and understanding of the following statements:

BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law.

Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page:

BCBST's EEO Policies/Notices

BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.