The Risk Adjustment Solutions Manager is subject matter expert and is responsible for developing and facilitating the implementation of new and existing healthcare Risk Adjustment strategies. This position advises other departments and clients on risk adjustment initiatives and provides risk adjustment educational programs; conducts data collection; and reporting and monitoring for key performance measurement activities.Job Description:
Manage a comprehensive Risk Adjustment strategy for our clients by: developing data mining strategies; facilitating collection methodology and an effective risk adjustment program; standardizing risk adjustment workflows; ensuring successful completion of internal/external risk-adjustment data validations (for RADV Audit); and developing and facilitating implementation of Risk Adjustment training program for internal and external clients.
Develop and maintain effective internal and external relationships through effective and timely communication.
Synthesize and organize data, present information, and provide executive summary of material.
Accountable for outstanding customer service to all external and internal customers.
Take initiative and action to respond, resolve and follow up regarding risk adjustment with all customers in a timely manner.
Develop and maintain an expert level of knowledge of Medicare and risk-based reimbursement methodologies.
Maintain professional and technical knowledge by attending educational workshops, reviewing professional publications, establishing personal networks and participating in professional societies.
Oversee and improve the various risk adjustment processes.
Facilitate the development of risk adjustment key performance indicators.
Present risk adjustment performance results and findings regularly including the overall RAF score, improvement strategies and tactics.
Serve as risk adjustment subject matter expert for internal and external clients.
Supports activities of internal RADV monitoring programs and internal and external RADV audits.
Performs other duties as assigned.
Bachelor’s degree in Health Administration, Business Administration or related field required
3 years’ experience within Healthcare, Health plan, or Health System required, including payer, hospital, Medicaid/Medicare, provider environment or managed care
Knowledge of Risk Adjustment Payment methodologies and understanding of the CMS HCC, HHS, and Medicaid
Detail oriented; possesses strong initiative and ability to set priorities
Ability to successfully manage multiple job functions under pressure with shifting priorities
Proficiency in Microsoft Office Programs including Word, PowerPoint, Excel, and Outlook
Excellent organizational capabilities with ability to work effectively as a team player
Strong aptitude for critical thinking and demonstrated data skills
Able to manage multiple priorities and deadlines in an expedient and decisive manner
Excellent interpersonal and communication skills
Ability to collaborate and work through all professional levels, internally and externally
Analytical and quantitative problem-solving skills
Ability to travel up to 30%
While performing the duties of this job, the employee works in normal office working conditions.
The job description describes the general nature and level of work being performed by people assigned to this job and is not intended to be an exhaustive list of all responsibilities, duties and skills required. The physical activities, demands and working conditions represent those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job duties and responsibilities.