MA Risk Adjustment Supervisor - TSS

MA Risk Adjustment Supervisor

Responsible for managing the Medicare operational area of the risk adjustment process and encounter data processing (EDPS) in accordance with CMS regulations. Provides oversight and leadership to the Risk Adjustment Operations department to ensure initiatives are aligned to support the goals and objectives of the organization.

Essential Duties and Responsibilities :

• Develop and implement strategies to ensure accuracy of risk adjustment payments.
• Align providers on revenue management strategy. In coordination with providers department, establish the plans and activities to ensure compliance.
• Responsible for identifying, managing and implementing strategic initiatives to accurately reflect risk adjustment revenue, and minimize risk.
• Develop resolution and plan for action for identified raps and EDPS discrepancies.
• Monitor and oversight vendor performance and contract. Manages, measures and evaluates vendor performance on an ongoing basis. Participates and assess vendor alternatives. Establish performance metrics for review and evaluation.
• Represent the organization in dealing with vendors for the risk adjustment program.
• Oversees the implementation of data management controls to ensure data quality and integrity; developing tracking, validation and reporting tools.
• Oversees risk adjustment data validation audits by government agencies or outside audit vendors, providing assistance to internal stakeholders and conduct medical record chart reviews to validate diagnoses.
• Perform claims and medical record reviews with focus on accuracy of diagnoses, as needed to respond to particular issues, as part of regulatory audit, or as element of oversight audit.
• Participates in the implementation of tactical plans, follows up on assigned tasks, projects, or objectives to ensure that expectations are met.
• Prepares production reports, statistics and presentations when required.
• Assist in special projects and / or initiatives of the corporation.
• Provide recommendations to achieve the Division's and Company's goals.
• Hires, trains, coaches, counsels, motivates and evaluates the performance of direct reports. Establishes disciplinary actions when necessary and promotes employee performance recognition when applicable.
• Responsible for preparing, assigning tasks, monitoring workflow and monitor day to day execution and employee activities.
• Other tasks as assigned by the Management and that are essential.

Education, Training, and / or Professional Experience :

Bachelor's Degree in Business Administration with a major in Accounting or Finance with three (3) to five (5) years of experience in an Accounting or Finance area, preferably in the insurance and health industry.

It is company policy to seek for the qualified applicants for positions throughout the company without distinction of race, color, national origin, religion, gender, gender identity, real or perceived sexual orientation, civil status, social condition, political ideologies, age, physical or mental disability, veteran status or any other characteristic protected by law. Drug-free company.

Equality Employment Opportunity / Affirmative Action for Minorities / Females / People with Disabilities / Veterans". Employer with E-Verify to verify the eligibility of employment of all the new employees.

We encourage Females, Veterans and Disabled to Apply