About Reveleer
Reveleer delivers a unified platform spanning risk adjustment, quality improvement, clinical intelligence, and member management for health plans and provider organizations navigating the complexity of value-based care. Trusted by 80+ customer organizations nationwide, the platform integrates data, analytics, and intelligent workflow automation into one governed system designed to support traceable documentation across diagnoses, quality measures, and submissions. With regulatory expertise and transparent, human-in-the-loop AI at its core, Reveleer supports organizations working to advance care quality, strengthen documentation integrity, and sustain the operational readiness needed to navigate audits with confidence.
Role Overview
The Risk Adjustment Team Lead will oversee day-to-day coding and abstraction operations, drive team productivity and quality, and ensure adherence to coding guidelines, regulatory requirements, and client commitments. The role requires strong risk adjustment expertise, hands-on operational involvement, team coaching, performance monitoring, and cross-functional collaboration to achieve production and quality targets.
Key Responsibilities
Production and Team Management
- Monitor daily team productivity and ensure coding targets, quality standards, and turnaround times are met.
- Allocate and balance coding assignments based on project priorities, workload, and team capacity.
- Track individual and team performance, identify gaps, and implement corrective actions.
HCC Coding Quality
- Ensure accurate HCC coding in accordance with ICD-10-CM guidelines, risk adjustment requirements, and client standards.
- Review quality reports and over-read feedback to identify coding errors and drive continuous improvement.
- Support the resolution of complex coding cases and implement corrective action plans to improve accuracy.
Team Leadership and Development
- Coach and mentor coders to improve coding accuracy, productivity, and overall performance.
- Conduct refresher training, support new-hire onboarding, and address identified knowledge gaps.
- Promote accountability, engagement, and continuous learning within the team.
Compliance and Audit Management
- Ensure adherence to coding guidelines, applicable regulatory requirements, HIPAA, and client-specific standards.
- Support coding audits and RADV activities, where applicable, and drive timely resolution of audit findings.
- Ensure compliance training and required coding assessments are completed on time.
Reporting and Process Improvement
- Monitor and report key metrics, including productivity, coding accuracy, quality scores, and turnaround times.
- Identify workflow inefficiencies and implement improvements to enhance coding quality and operational efficiency.
- Escalate coding, quality, and operational risks to Management with appropriate recommendations.
Cross-Functional Collaboration
- Collaborate with Managers, QA teams, and other stakeholders to resolve coding issues and meet project objectives.
- Support coding guideline updates, system enhancements, and process changes, ensuring effective communication and implementation.
Required Skills
- Minimum of 6 years of medical coding experience, with strong expertise in Medicare Advantage and commercial risk adjustment, including HCC coding.
- Current coding certification through AAPC and/or AHIMA, such as CPC, CPC-P, CPC-H, CPC-I, CRC, CCS, RHIT, or RHIA.
- Prior experience as an SME, senior coder, quality reviewer, or team lead; supervisory or team management experience is strongly preferred.
- Strong knowledge of ICD-10-CM coding guidelines, HCC models, risk adjustment methodologies, medical terminology, anatomy, and pharmacology.
- Experience in HCC coding, coding quality reviews, over-read processes, and coding audit resolution.
- Demonstrated ability to meet productivity, coding accuracy, and quality targets.
- Proficiency in Microsoft Excel, coding platforms, and relevant healthcare applications.
- Excellent analytical, problem-solving, communication, and team management skills.
Preferred Skills
- Additional experience with Health Plan Risk Adjustment Data Validation (RADV) audits and audit readiness.
- Additional experience in facility coding, including OPPS/IPPS.