Director, Coding & Risk Adjustment
Galileo is a team-based medical practice working to improve the quality and affordability of health care for all. Operating across 50 states, Galileo offers high-touch, data-driven, multi-specialty, longitudinal care to diverse and complex patients—on the phone, in the home, and everywhere in between. Regional and national health plans, employers, and Fortune 500 organizations trust Galileo as the leading solution to improve population health. Founded by Dr. Tom X. Lee, the healthcare pioneer behind One Medical and Epocrates, Galileo is a team of leading innovators from healthcare, technology, and human-centered design. Our mission is to apply that talent and scientific thinking to transform society by solving our largest, toughest healthcare problems, while at the same time bringing patient and provider closer.
ABOUT THE ROLE
This individual will oversee Galileo’s medical coding and risk adjustment operations. We are looking for someone who can work cross-functionally with business operations, product, and other teams to ensure efficiency and compliance of our medical record systems and billing processes. This role will also work with other RCM leaders and teams to oversee and assist with claims processing.
Here’s what you’ll do:
- Oversee and operationalize coding and CDI programs to drive best practices for complete and accurate documentation of patient health status
- Lead revenue cycle strategic planning and execution, and implementation of standardized processes and procedures.
- Lead education programs for clinicians on coding/documentation best practices
- Partner with product, engineering, and data teams to optimize revenue cycle and risk adjustment initiatives
- Oversee compliance and appropriate audit programs for all coding and CDI practices
- Interpret data, financial metrics and provide reporting to executive leadership.
- Work with organization leaders to develop KPIs, performance dashboards, and reporting to drive operational performance
- Contribute to the design of a proprietary EHR to support both coding and documentation best practices, and ensure compliance and regulatory standards are met
- Implement, and manage vendors for outsourced coding services.
- Answer coding questions, provide documentation recommendation and best practices in a realtime environment
You should love problem solving and have a knack for making documentation and revenue cycle processes more efficient and quick, while maintaining compliance. You thrive in a growing startup environment and can be adaptable while remaining organized. You are passionate about data and making data-driven decisions.
We would love to hear from you if you have the following or equivalent experience:
- 5+ years in a Medicare risk adjustment coding leadership role is a must. Experience in Commercial / ACA and Medicaid Risk adjustment.
- 3+ years analyzing risk adjustment data, comprehensive understanding of cohort analysis, diagnosis prevalence, suspected gap logic.
- Experience in the Risk Adjustment Data Validation (RADV) rebuttal process would be highly preferred, but basic experience with an audit or mock audit (healthplans mocks) is extremely helpful.
- Ability to perform internal audits for both E/M and Risk Adjustment, to include creating improvement plans, communicating audit results / next steps to providers, and presenting audit results to executive leadership.
- Working knowledge of regulatory requirements pertaining to health care operations and their impact on cross functional organizational operations.
- Experience in multiple EHRs
- Experience overseeing departmental charge capture, reconciliation, denials management, A/R management and reporting.
- CPC, CCA, or CCS certifications required.
$130,000-$150,000 annually based on experience and market dynamics + equity
- Medical / Dental / Vision insurance
- Flexible Spending Account
- Health Savings Account + match
- Company paid STD/LTD, AD&D, and Life insurance
- Paid Family Leave
- 401K + match
- Paid Time Off
HOW WE HIRE
Galileo is committed to hiring the best team possible to build health care that works for everyone. We value a diverse set of perspectives to deliver the best possible solutions to those problems. We look for talent from a wide range of backgrounds—including, but not limited to—race, age, sexual orientation, gender identity and expression, national origin, religion, disability, and veteran status. Galileo is an Equal Opportunity Employer and provides reasonable accommodations to applicants and employees with a qualifying disability or conflict with a sincerely held religious belief, unless doing so would cause an undue hardship or fail to eliminate a direct threat.