The Program Manager will lead a team supporting diagnosis validation for the CMS RADV program and manage program financial performance. They are responsible for updating training documentation, conducting coding case reviews, and maintaining regular communication with CMS stakeholders.
Position: Program Manager Location: Remote, Eastern Standard Time (EST) based. Flexibility for occasional travel to Baltimore, MD. FLSA Status: Non-Exempt, Part-Time Reports To: Vice President of Programs & Delivery
About J29 J29, Inc. is a healthcare management consulting firm supporting federal, state, and local health and human services programs. J29 delivers specialized expertise in areas including claims processing and analysis, medical review, adjudication, appeals and dispute resolution, program integrity, compliance, and data analytics. Through a combination of experienced professionals, disciplined program management, and a mission-focused approach, J29 helps its clients operate complex healthcare programs effectively while maintaining a strong focus on quality, performance, and measurable outcomes.
General Description J29 is looking for an experienced Program Manager (PM) to lead a small-sized team responsible for supporting diagnosis validation for Medicare Advantage data as a part of the Centers for Medicare and Medicaid Services’ (CMS) Risk Adjustment Data Validation (RADV) program. This role will provide general program management, small-team personnel management, and provide expert National RADV medical record coding expertise to stakeholders within the CMS RADV program. Within this role, the PM will be responsible for updating training documentation, supporting risk adjustment research and validation, RADV system, technical changes, reporting, and administrative functions. The J29 PM will work with upper management, back-office functions, J29 medical coders, and other clinical personnel to effectively lead J29’s RADV program. Additionally, this role will provide subject matter expertise across other J29 programs at CMS involving medical coding, as needed.
Duties
Ensures that program deliverables are being met by J29 team, including but not limited to; high level coding case reviews, training materials, training sessions, participation in coding panel discussions
Responsible for presenting and preparing program reports and frequents updates to CMS staff on a regular / proactive basis
Support training initiatives, and provide training to MRR coding contractors for RADV audits for CMS.
Review and provide support on “escalated” medical coding cases that require high-level expertise for proper diagnosis assignment.
Collaborate and communicate frequently with RADV and CMS stakeholders, both internal to J29 and external.
Collaborate and communicate frequently with RADV and CMS stakeholders, both internal to J29 and external.
Research ICD coding inaccuracies for possible deletions or code replacements.
Own program financial performance, including the program budget, forecasts, and profit and loss (P&L), in close collaboration with J29’s internal Finance team; support budget development, forecast updates, and reviews of actual results against plan to identify variances and corrective actions.
Partner with J29’s internal Contracts and Compliance team to understand, track, and fulfill contractual obligations under the program, including deliverables, reporting requirements, and performance standards; identify and escalate contractual risks and coordinate actions to maintain compliance.
Other advisory or consultative duties, as assigned, that support other J29 programs or functions that are aligned to medical coding background and expertise of PM.
Qualifications
4+ years of experience with general project or program management, holding responsibility with direct reports and budgeted financial involvement.
2+ years of experience within, or in support of, the CMS RADV program – including audits or coding.
Experienced with ICD-9/ICD-10 medical record coding standards, and the conversion of ICD-9 to ICD-10
Expert experience of using AHA Coding Clinic and other official resources to research coding questions and generate proper training materials
2+ years of recent generalized medical coding experience
2+ years of experience providing training, or developing training materials related to medical coding, in support of the RADV program
Strong written and verbal communications demonstrated in prior related roles working independently in a remote environment
Thorough experiences with client stakeholder management, communication, and reporting requirements.
Technically savvy, with high level competence using computers and collaboration tools
Education Requirement
Bachelor’s Degree in Business Administration or related studies
Optional: hold one or more of RHIT, RHIA, CCS, and/or AHIMA certification
Pay rate: $40.86-45 hourly
J29, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
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