In my previous role as a Compliance Manager, I was responsible for overseeing the implementation of risk adjustment methodologies across various healthcare programs. I collaborated with data analysts to ensure accurate patient risk scores were calculated and reported to CMS. This involved training staff on the latest HCC coding guidelines and conducting regular audits to verify compliance. My approach was to create a robust system of checks and balances to minimize errors and ensure timely submission of accurate data.

I stay current by regularly attending industry conferences, webinars, and training sessions focused on risk adjustment and compliance. I also subscribe to key publications and regulatory updates from CMS and other relevant bodies. Additionally, I maintain a network of peers and experts in the field to discuss emerging trends and changes. This proactive approach ensures that our compliance strategies are always up-to-date and aligned with the latest regulatory requirements.

In a previous role, I discovered a discrepancy in the risk adjustment data that indicated potential underreporting of HCC codes. I immediately initiated an internal audit to investigate the issue. After identifying the root cause, which was a lack of training on the latest coding guidelines, I organized comprehensive training sessions for the coding team. I also implemented a new auditing process to prevent future occurrences. This proactive resolution ensured compliance and improved the accuracy of our risk adjustment reporting.

I prioritize tasks by assessing their urgency and impact on compliance and risk adjustment accuracy. I use a combination of tools such as task management software and daily checklists to ensure nothing falls through the cracks. I also delegate responsibilities to my team based on their strengths and expertise. Regular communication and status updates help keep everyone aligned and focused. This structured approach allows me to manage multiple high-priority tasks efficiently, even in a high-pressure environment.

I would develop a comprehensive training program that includes regular workshops, online modules, and hands-on exercises tailored to different roles within the organization. I would also establish a mentorship program where experienced staff can guide newer team members. Additionally, I would create a knowledge-sharing platform where staff can access resources and share best practices. Quarterly performance reviews would include feedback on training needs, ensuring continuous improvement and compliance with evolving regulations.