Risk Adjustment Manager- Operations

The Risk Adjustment Operations Manager plays a critical role in the development and execution of the corporate risk adjustment strategy for the acquisition and coding of medical records. The role serves as a dedicated resource within the organization for Medicare Advantage, Medicaid and ACA markets, coordinating and leading the end to end strategy by applying improvements and driving cost-effective risk adjustment actions across all organizational populations and products. ESSENTIAL FUNCTIONS: • Proactively create, manage and communicate data collection and coding related KPIs, OKRs, ROI, action plans, progress and risks within organizational teams. Develop and manage tracking tools, dashboards, surveillance programs and metrics for monitoring the progress of the operations in collaboration with cross-functional teams and senior leadership. • Conduct impact analysis and formulate actions related to all risk adjustment-related regulatory changes across and implements appropriate changes and processes to impact business outcomes in collaboration with leadership across related teams. Collaborate across the eco-system such as HHS, CMS, State, BCBSA, etc. to drive necessary regulatory improvements. • Provide support, education and training to staff to build risk awareness within the organization and achieve departmental goals. Recruit, retain, and develop a high-performing team. Evaluate the performance of each team member, generate development plans and set goals within the context of the corporate policies and procedures. Develop annual goals, and assists with the oversight of departmental budget to control and appropriately allocate resources. • Act as a liaison between the business units and the risk adjustment group by promoting a positive environment of collaboration and excellent customer service. Serve as an SME to guide the key stakeholders in bid filings, regulatory filings, and financial performance planning and reporting. SUPERVISORY RESPONSIBILITY: This position manages people. QUALIFICATIONS: • Education Level: Bachelors Degree OR in lieu of a Bachelors degree, an additional 4 years of relevant work experience is required in addition to the required work experience. • Experience: 5 years experience of progressive responsibility in a healthcare payor environment. 1 year experience with supervisory or demonstrated progressive leadership experience within Government Programs and Risk Adjustment functional areas. • Preferred Qualifications: Masters in business administration, Masters in Health Administration or Masters in Public or Population health. Knowledge, Skills and Abilities (KSAs) • Knowledge and experience across all regulatory guidelines on Risk Adjustment. • Experience successfully planning and leading presentations to physicians, internal stakeholders, and C-suite with a focus on coding data and analytics. • Experienced with effective physician/provider collaborative training to support workflow adjustments to improve clinical coding quality. • Successful completion of a Coding Certificate program from an accredited organization (i.e., CPC, CRC, CPMA from AAPC, or CCS, CCS-P from AHIMA). • Strong leadership skills, vendor oversight skills and an experience in payer, provider and industry collaboration. • Ability to work in a fast-paced environment and drive consistent actions across a matrixed environment.