Oversee day-to-day operations and strategic execution of enterprise risk adjustment programs
Develop metrics, policies, and procedures in support of required deliverables
Serve as a strategic partner to business leadership
Influence and work effectively to establish and develop working relationships
Obtain and comply trend data and educate providers
Collaborate with the operations risk and compliance teams
Drive remediation of risks and issues by collaborating with Business Operations, Internal Audit and Regulatory Compliance
Provide oversight and ensure complete and accurate coding for Medical Revenue Management programs
Lead and consult with operations on ad hoc requests/special projects
Oversee daily operations of risk adjustment programs across prospective and retrospective initiatives

Requires a BA/BS in a related field
Minimum of 5 years of experience in a managed care setting
Extensive risk adjustment experience with a focus on CMS audit experience
Coding knowledge strongly preferred
MBA or MHA in Healthcare Administration preferred
Experience working on the payer side of the health insurance industry strongly preferred
Strong understanding of risk adjustment models
Experience working directly with providers and/or provider group leadership strongly preferred
Preferred background in Clinical Documentation Improvement (CDI) and medical coding practices
Certified coder credential preferred (e.g., CPC, CRC, CCS, RHIT, RHIA).
Moderate to advanced proficiency in Microsoft Excel, Tableau, or other data reporting and analytical tools preferred.

Risk Adjustment Strategic Manager

Key skills