Senior Manager, Risk Adjustment Analytics in Denver

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Senior Manager

to join our Integrated Kidney Care (IKC) Revenue Analytics team, responsible for all CMS risk adjustment?related analytics. This role will lead the financial and strategic aspects of risk adjustment, providing actionable insights that inform executive?level decision?making. The ideal candidate will have a strong background in analytics, finance, and risk adjustment, with the ability to translate complex data into strategic recommendations. This is an exciting opportunity to shape the direction of risk adjustment analytics within a dynamic and growing organization. Essential Responsibilities

Provide strategic leadership and management for the IKC Risk Adjustment Accuracy. Create and maintain leadership reports on IKC revenue financials and estimate the impact of IKC initiatives on Medical Loss Ratio (MLR). Write SQL queries against data warehouses containing clinical operations and medical claims data to support analytic requests and deliver insights to various stakeholders. Monitor evolving regulations and policies to ensure all processes and reporting meet compliance requirements. Partner with clinical, financial, operational, legal, compliance, and IT teams to improve risk adjustment accuracy. Serve as a subject matter expert on CMS risk adjustment for the enterprise and stay current on the latest industry trends. Perform other duties as assigned. Required Experience

3+ years of professional experience with healthcare data, specifically medical claims and/or encounter data using SQL. 3+ years of experience in healthcare financial management, healthcare consulting, medical economics, population health, or similar fields. At least 1 year of experience in the creation, implementation, and impact estimation of prospective and retrospective risk adjustment initiatives, including CMS RAPS/Encounter data submissions. Experience developing and managing direct reports. Skills and Knowledge Needed

Expert?level knowledge of CMS?HCC models V24 and V28, claims data lifecycle, submission systems, regulation, compliance, and audits related to risk adjustment. Strong understanding of healthcare economics, population health, and value?based care. Ability to work collaboratively in a cross?functional team environment and communicate effectively at all organizational levels. Comfortable presenting complex analysis and insights to executive audiences. Intellectual curiosity, strategic thinking, and strong project management skills. Ability to thrive in ambiguous, ever?changing situations. Strong entrepreneurial mindset with motivation to continuously improve processes independently. Benefits

Comprehensive benefits including medical, dental, vision, 401(k) match, paid time off (PTO), and PTO cash out. Support for work-life balance including family resources, counseling sessions, and backup child/elder care. Professional development programs and access to virtual leadership and development courses. If you are interested in applying for this job please press the Apply Button and follow the application process. Energy Jobline wishes you the very best of luck in your next career move. #J-18808-Ljbffr