We are currently hiring a Risk Adjustment Program Manager! If you have strong project management and analytical skills, risk adjustment program management experience, and value being part of a team that makes a difference, you may be the right person for the position! Apply today!
JOB PURPOSE: Risk Adjustment Program Manager
This position is responsible for implementing and managing the Medicare and Medicaid Risk Adjustment Program strategy to ensure the accurate documentation of Member conditions and appropriate plan reimbursement to support quality patient care. The Risk Adjustment Program Manager will serve as the primary risk adjustment liaison for all involved stakeholders, including Quality, Finance, Analytics, the leadership team. This position requires the technical, analytical, and interpersonal experience needed to identify, analyze, and solve problems related to HCC coding, encounter accuracy, and stakeholder education.
ESSENTIAL RESPONSIBILITIES: Risk Adjustment Program Development and Management
- Serve as a primary contact and subject matter expert for the Medicaid and Medicare Risk Adjustment Programs, staying up to date on industry trends and evolving payment policies
- Develop and implement the annual risk adjustment strategy, working closely with leadership to ensure alignment with company goals
- Develop provider incentives to improve the accuracy of diagnosis documentation
- Use analytics to define risk adjustment focus and identify opportunities to increase coding accuracy and completeness
- Build and maintain excellent relationships with risk adjustment vendors, coordinate their day-to-day operations, and ensure adherence to vendor agreements
- Plan, implement, and maintain risk adjustment program projects, including but not limited to following project plans and timelines, coordinating, and facilitating meetings of project stakeholders, tracking, and communicating project statuses, and tracking project timeframes and deliverables
- Develop and direct provider training related to risk adjustment.
- Develop and distribute accurate and actionable risk adjustment reports and ensure timely distribution to providers
- Assist in the development and revision of current policies and procedures relevant to program activities
- Identify issues determined to impact risk adjustment, and work with the affected teams to resolve those issues in a manner that complies with all applicable internal and external governing rules and regulations
- Track and report findings of chart audits and opportunities to improve documentation and coding back to providers and staff
- Support ongoing audit system to assure that improved documentation and coding occurs in a timely manner
- Ensure compliance with company policies and procedures as applicable to area(s) of responsibility
- Handle confidential information and materials appropriately and maintains a secure work area
ESSENTIAL RESPONSIBILITIES: ORGANIZATIONAL TEAM MEMBER
- Participate in quality and organizational process improvement activities and teams when requested
- Support and contribute to effective safety, quality, and risk management efforts by adhering to established; policies and procedures, maintaining a safe environment, promoting accident prevention, and identifying and reporting potential liabilities
- Openly, clearly, and respectfully share and receive information, opinions, concerns, and feedback in a supportive manner
- Work collaboratively by mentoring new and existing co-workers, building bridges, and creating rapport with team members across the organization
- Provide excellent customer service to all internal and external customers, which includes team members, members, students, visitors, and vendors, by consistently exceeding the customer's expectations
ESSENTIAL RESPONSIBILITIES: Professional Development
- Recognize new developments and remain current in risk management and program development best practice standards and anticipate organizational modifications
- Advance personal knowledge base by pursuing continuing education to enhance professional competence
- Promote individual and organizational integrity by conducting oneself in an ethical manner
- Represent organization at meetings and conferences as applicable
QUALIFICATION, EDUCATION, AND EXPERIENCE REQUIREMENTS
- Bachelor's Degree in mathematics, business, project management or other related field required, experience in lieu of education will be considered; Master's degree strongly preferred
- A Minimum of 3 years of experience in Medicaid and/or Medicare risk adjustment
- A minimum of 3 years of medical coding experience
- Experience developing and maintaining risk adjustment programs, requirements and data required
- Experience leading, training, and managing a team
- Certified Professional Coder or Certified Risk Adjustment Coder strongly preferred
KNOWLEDGE, SKILLS, AND ABILITIES
- Adept knowledge of federal and state regulations as related to Medicaid and Medicare Risk Adjustment
- Thorough knowledge of research and investigation practices
- Knowledge and demonstrated understanding of CDPS Rx and CMS-HCC risk adjustment models
- Extensive knowledge of ICD-10 coding guidelines
- Knowledge and understanding of how the positions' responsibilities contribute to the department and company goals and mission
- Knowledge of federal and state laws including OSHA, HIPAA, Waste Fraud and Abuse
- Strong problem- solving and anticipation skills
- Skill in change management, conflict resolution, interpersonal relationship, quality management, systems thinking, teamwork, leadership, facilitation, and project management
- Excellent financial planning and budgeting skills
- Excellent vendor management skills, effectively identifying, researching, and remediating issues timely and efficiently
- Ability to manage multiple priorities, deliver timely and accurate results while ensuring departmental needs are met
- Proven success in preparing and delivering presentations that convey information critical to the audience and adjusting to meet changing audience needs
- Excellent organizational, project and program management skills; experience leading change and implementing programs
- Strong quantitative and analytical skills with the ability to communicate data concisely and clearly to a variety of audiences
- Demonstrated ability to be an effective, collaborative partner with internal and external stakeholders
- Awareness and understanding of equity, equity lens, diversity, and inclusion
- Training in or awareness of Health Literacy, Poverty Informed, Systemic Oppression, language access and the use of healthcare interpreters, uses of data to drive health equity, Cultural Awareness, Trauma-Informed Care,
- Adverse Childhood Experiences (ACEs), Culturally and Linguistically Appropriate Service (CLAS) Standards, and
- universal access
- Proficient in Microsoft Office Suite
- Non-judgmental attitude
- Ability to lead cross functional internal teams to execute on complex tasks in a growing and changing environment
- Ability to report to work as scheduled and work a flexible schedule when circumstances necessitate
- Ability to handle stress and sensitive situations effectively while projecting a professional attitude
- Ability to work with diverse populations and interact with people of differing personalities and backgrounds
- Sensitive to economic considerations, human needs and aware of how one's actions may affect others
- Ability to organize and work in a sensitive manner with people from other cultures
- Poised; maintains composure and sense of purpose
WORKING CONDITIONS
This position must have the ability to remain in a stationary position, occasionally move about in an inside environment access office machinery and frequently communicate and exchange accurate information.
- Work Condition:
- Employee generally works within the interior of an office environment or a remote environment.
- Employee may travel locally and be responsible for own transportation. Out of area travel may be required on occasion.
- Hours of operations and specific staff scheduling may vary between worksite based on operational need.
- Machines, equipment, tools and supplies used: Constantly operates a computer or other office productivity machinery, such as postage machine, fax, copier, calculator, multi-line telephone system, scanner
- May answer a high volume of electronic and telephonic communication, complete documentation, and use computer programs to either obtain or record information
- Multiple Duties: Must be able to work under conditions of frequent interruption and be able to stay on task.
This job description is intended to provide only basic guidelines for meeting job requirements. This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of DOCS Management Services employees. Other duties, responsibilities and activities may change or be assigned at any time with or without notice.
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