Landmark Health

Manager, Risk Adjustment Operations

Job Locations US-Remote
Posted Date 2 months ago(4/7/2020 11:32 AM)
Category
Operations
Type
Regular Full-Time
Job ID
2020-3870

Overview

The Manager, Risk Adjustment Operations will be a critical member of the Revenue Management team, supporting the Risk Adjustment Operations of the company. This role will oversee all Risk Adjustment Program operations including prospective and retrospective initiatives, analysis and reporting of program effectiveness and supports supplemental encounter submissions to Medicare health plans.

 

Responsibilities

  • Oversees National Risk Adjustment operations including performance improvement, optimization, and managing deployment of risk adjustment activities and programs.
  • Uses analytics to develop and execute projects and programs that optimize Risk Adjustment performance across the organization.
  • Performs as liaison among external vendors and internal stakeholders for all Risk Adjustment programs throughout the enterprise.
  • Tracks, measures, and reports on vendor performance against financial and contractual standards to Revenue Management Leadership.
  • Interacts with vendors on a routine basis to ensure adequate communication regarding goal setting, performance review, audit follow ups, and compliance with policies and workflow guidelines.
  • Manages day to day operations of Data Analyst team, motivating team to exceed department goals and objectives through execution of clearly defined processes and collaboration with inter and intra departmental stakeholders.

Qualifications

  • BA/BS degree required; MBA is strongly preferred.
  • 5-10 years’ experience in a healthcare insurance setting including Medicare/Medicaid Risk Adjustment – CPC or CRC a plus.
  • 5 or more years of which involve management of risk adjustment programs, encounter submission management, data management, or claims processing for government contractors (e.g. Medicare).
  • A minimum of 2 years’ experience in project or program management demonstrating proficiency in handling multiple projects – including prioritization, planning, and task delegation.
  • 2-3 years of increasing supervisory or management experience in a health care setting.
  • Proven track record demonstrating leadership skills, critical thinking, proactive operational excellence, and problem solving.

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