Risk Adjustment Manager- Encounters

The Risk Adjustment Manager plays a critical role in the development and execution of the corporate risk adjustment strategy. 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 Risk Adjustment related encounter or submission KPIs, OKRs, ROI, action plans, progress and risks within organizational teams. Develop and manage tracking tools, dashboards, and metrics for monitoring the progress of the encounter integrity and submission accuracy 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, States, 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 :

Knowledge, Skills and Abilities (KSAs)