Risk Adjustment Manager- Encounters (Hybrid)

Resp & Qualifications

PURPOSE :

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

Education Level : Bachelor\'s Degree OR in lieu of a Bachelor\'s 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 regulated markets and mandated risk adjustment submission process & platforms. Expert in regulatory guidelines on Risk Adjustment.

Experience successfully planning and monitoring performance to 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.

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.

Salary Range

$105,040 - $194,981

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate\'s work experience, education / training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case\'s facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs / plans, and 401k contribution programs / plans (all benefits / incentives are subject to eligibility requirements).

Department

Risk Adjustment

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Where To Apply

Please visit our website to apply : www.carefirst.com / careers

Federal Disc / Physical Demand

Note : The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him / her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship.

LI-NH2

REQNUMBER : 21271

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