Senior Manager, Risk Adjustment Coding Management (Medicare)

Senior Manager, Risk Adjustment Coding Management (Medicare)

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Overview

The Senior Manager, reporting to the Senior Director in Risk Adjustment, will manage 3-4 direct reports in Medicare risk adjustment coding using Epic EMR and RA standards. Responsibilities include developing and maintaining risk adjustment policies, conducting audits (RADV, HHS, OIG), and ensuring compliance with regulations.

Key Responsibilities

• Lead risk management programs, conduct audits, and analyze risk data to improve processes.
• Manage teams, set goals, and ensure policy compliance and staff development.
• Oversee regulatory audits and ensure adherence to federal and state laws.
• Provide strategic guidance on risk issues, develop response protocols, and manage incident investigations.
• Develop and deliver risk management training and education programs.
• Monitor threats and risks, analyze data, and collaborate across departments for risk mitigation.

Minimum Qualifications

• At least 1 year managing operational or project budgets.
• At least 4 years in a leadership role with direct reports.
• Minimum 5 years using medical terminology.
• Minimum 3 years in program/project management.
• Bachelor’s degree in relevant field plus 6 years of risk management experience, or 9 years of related experience.

Additional Requirements

• Knowledge of confidentiality, risk assessment, legal risk management, health information systems, compliance, and data analysis.

Details

• Seniority level: Mid-Senior level
• Employment type: Full-time
• Job function: Finance and Sales
• Industry: Hospitals and Health Care

This job posting is active. Salary range: $142,600 - $325,800.