Manager of Risk Adjustment

Location: St. Louis, MO
Date Posted: 03-11-2019
Manager of Risk Adjustment - Managed Care
St. Louis, MO (Western Suburb near Chesterfield)

Manager of Risk Adjustment Job Summary:
  • Manage the business processes related to risk adjustment and quality improvement for assigned products and plans. 
  • Develop and implement action plans, across all departments affecting assigned products and plans, to address issues identified by the business units, including detailed workplans, issue logs, and progress reports
  • Identify and partner with various departments to implement assigned products business requirements
  • Develop and execute operational workflows specific to each product business requirements, competitive landscapes, and local market dynamics
  • Evaluate and manage the risk adjustment strategy across all functional areas that impact assigned products
  • Identify and support health plan initiatives related to assigned products
  • Prepare dashboards for senior management and identify improvement opportunities
Manager of Risk Adjustment Background:
  • Requires a Bachelor’s Degree in public health, health information, nursing, business or healthcare administration, etc.
  • Requires 4 years of experience in healthcare risk adjustment, project management, operations, data analysis/reporting, or quality improvement; preferably at a Payer or other Managed Care Organization.
  • Around 1-2 year’s supervisory experience, leading, supervising, or managing a team or a program/project.
  • Experience with CMS Risk Adjustment submission, RAD-V, analysis and running claims to identify Risk Adjustment gaps.
  • Strong working knowledge of State and Federal regulations, including the Centers for Medicare & Medicaid Services.
  • Strong interpersonal skills needed to interact with providers on coding improvement initiatives and identified findings.
  • Strong analytical mind, with problem solving and investigative skills, an aptitude for accuracy, and attention to detail.
  • Ability to look at large data sets to analyze and identify trends in conditions of patients and review medical records to determine if the coding is correct.
  • Must be computer literate and knowledgeable in MS Office and program management software.
  • Possess superior verbal and written communication skills, able to interface with business and medical professionals. 

Manager of Risk Adjustment Benefits: 

This established, nationally-recognized organization is a Fortune 500 company that is committed to the health and happiness of all their staff. They offer a comprehensive benefits package to all full-time, permanent employees including low cost health insurance plan, dental, vision, and life insurance. To assist employees in living a healthier life, they offer either on-site fitness center or discounts to local fitness centers and a comprehensive wellness programs. They also offer free or reimbursed parking, tuition assistance, matching 401(k), employee stock purchase plan, generous PTO plus paid holidays, and much more!

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