Also referred to as:
Health Risk Adjustment Analysis Manager, Insurance Risk Adjustment Analysis Manager, Insurance Risk Rating Analysis Manager
Requirements and Responsibilities
Risk Adjustment Data Analysis Manager manages an organization's risk adjustment processes to assess patient risk scores and ensure accurate reimbursement calculations. Utilizes patient health factors, their likely use of health care services, and the costs of those services to calculate payment adjustments, forecast revenue impacts, and identify coding gaps. Being a Risk Adjustment Data Analysis Manager implements processes and standards to ensure accurate, timely, and compliant reporting to government agencies for determining risk adjustment payments. Monitors risk adjustment performance and leads and executes strategies to optimize financial performance while maintaining regulatory compliance. Additionally, Risk Adjustment Data Analysis Manager coordinates audit readiness and responses to regulatory data validation reviews. Partners with coding, compliance, and clinical teams to enhance data completeness and accuracy. Requires a bachelor's degree. Typically reports to a director. The Risk Adjustment Data Analysis Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. To be a Risk Adjustment Data Analysis Manager typically requires 5 years experience in the related area as an individual contributor. 1-3 years supervisory experience may be required. Extensive knowledge of the function and department processes.
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