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Risk adjustment manager, vnsny choice

Choice Hr

This is a Full-time position in Walton, NY posted November 29, 2019.

Maximizes revenue strategies for CHOICE Medicare Advantage products.

Coordinates multiple cross functional activities and projects related to risk adjustment across all CHOICE departments as well as interactions with external vendors.

Strong understanding of healthcare operations and the ability to analyze data and processes to assist senior leadership in formulating various risk adjustment initiatives.

Oversees the performance of the person(s) and vendors in charge of chart audits, home visit assessments and the performance of internal resources devoted to the Hierarchical Condition Category/Risk Adjustment Factor (HCC/RAF) efforts.

Collaborates with the data science and business intelligence teams to determine potential data analytics initiatives with the focus on improving operations to improve risk score accuracy.

Serves as a liaison between the various CHOICE departments including but not limited to Finance, Service Ops, Medical Management, Business Intelligence, Provider Relations, Compliance and Quality.

Maintains relationships with external vendors and provides ongoing support to manage initiatives across Risk Adjustment.Possesses strong working knowledge of Medicare Risk Adjustment methodology, Medicare payment policies, coding and documentation practices, and process improvement and optimization techniques.Manages risk adjustment vendor agreements.

This includes comparing fees, financial and quality performance against competitors on an on-going basis, and reviewing risk metrics with senior leadership.Develops and maintains an expert level of knowledge of Medicare and risk-based reimbursement methodologies.Has a strong understanding of encounter and risk adjustment data and is able to identify gaps and recommend strategic initiatives for revenue maximization.Serves as a key contributor to develop and implement of the annual risk adjustment strategy.

Works closely with the product management team and assists in annual Medicare bidding process as needed.Closely tracks the submission of routine federal and state data filings, report delivery to and from vendors and providers, and generally ensure that data is transmitted completely, correctly, and on time.Presents HCC/RAF performance results and findings to IPA’s and individual physicians, including the overall HCC/RAF score, improvement strategies and tactics.Education: Bachelor’s Degree in Business Administration, Finance, Health Care Administration, or other related field required.

Master’s degree in Business, Health Administration, Health Policy or related discipline preferred.Experience: Minimum of five years experience working with health care plans and Medicare and Medicaid programs.

Working knowledge of CMS and/or Medicaid risk adjustment methodologies required.

Operational knowledge of provider relations, claims, and medical management required.

Prior experience with Medicare risk adjustment, project management and leading cross-functional complex time sensitive projects required.

Prior experience with Medicare Risk adjustment is required.

Strong organizational, analytical, financial, communication and presentation skills required.

Proficiency in strategic thinking, problem solving and advanced excel skills required.