Manager Risk Revenue
Less than 5 years experience • Managed Care & Health Insurance
Seeking a Manager Risk Revenue for a large healthcare organization in Pittsburgh, Pennsylvania. This position will be responsible for creating plans and managing activities in support of governmental products where risk adjustment methodologies apply. Direct the daily activities of direct reports supporting risk adjustment programs and activities. Assesses viability of current direction, projects and operations, recommending strategies and tactics to satisfy current and future business needs. Actively seeks and identifies opportunities for improvement. Implements strategic and tactical improvements to the risk adjustment program and processes. Contributes to the establishment of strategic direction on the risk adjustment program. Manage information that will ensure accurate revenue projections.
Contribute to the department’s strategic planning efforts by identifying both strategic and tactical opportunities for improvement and recommending solutions. Provide day-to-day managerial oversight for staff responsible for risk adjustment programs and activities. Ensure continuous improvement of processes and delivery of results within assigned area. Encourage innovation and focus resources, including staff not under direct managerial control, to ensure successful delivery of desired results. Optimizes the use of resources in assigned area using proven resource management techniques. Assess the impact of potential or actual regulatory changes impacting the assigned area. Ensure ongoing compliance in all activities within the assigned area. Oversee development and execution of processes that will support the capture of complete and accurate diagnosis coding. Work closely with management from other areas to ensure that appropriate processes are in place to increase data accuracy. Accountable to deliver on initiatives requiring cross-functional, matrix relationships. These initiatives may involve staff in different departments or business units within the organization, or vendors and/or strategic business partners. Identify riskassociated with inaccurate coding and risk scores which could result in lost revenue, disadvantages relative to competitors and potential CMS sanctions or penalties and work with management to mitigate this risk. Participate in the identification, evaluation, and management of risk adjustment-related vendors, with an annual vendor spend that is over $35M that generates revenue in excess of $100M. Assist with the preparation of RFPs, evaluation of responses, selection of vendors, and execution of pilot programs or proof-of-concept efforts. Oversee the creation of presentations, reports, and documentation; collaborate and negotiate with departments who are stakeholders in or dependencies of the risk adjustment processes. Partner with PMO, stakeholders, IT, and others to deliver and maintain the infrastructure needed to support the risk adjustment processes, as well as analytics for both Stars and revenue management.
Bachelor’s degree in business or health administration, statistics, finance, information technology, or related field. 3-5years experience in a health insurance field. 3-5years experience mentoring others. Prior management experiencepreferred. Extensive knowledge of health insurance and/or provider operations. 2years experience in developing strategic and tactical solutions to diverse and complex business problems. 2years experience in developing, communicating, and presenting concepts to varying audiences. 3years experience using project management techniques. 2years experience in Risk Adjustment. Experience with SAS, SQL and Teradata.