Senior Manager of Risk Adjustment

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

Manager of Risk Adjustment Job Summary:
  • Oversee the risk adjustment coding and data validation programs.
  • Monitor daily queue volumes, prepare executive reports, oversee the coding of risk adjustment audits, develop & support risk adjustment infrastructure and maintain ROI by managing various inputs/outputs.
  • Evaluate and manage the risk adjustment strategy across all functional areas that impact assigned products
  • Develop and maintain all policy and procedures for departmental processes
  • Develop and implement action plans by partnering with all departments affecting assigned products and plans, to address issues identified by the business units, including detailed work plans, issue logs, and progress reports
  • Assist in composing provider education for correct coding according to state and federal risk adjustment guidelines
  • Work with vendor coding leadership to ensure risk adjustment work being undertaken on behalf of Centene meets all state and federal guidelines for risk adjustment code capture and contractual service level agreements
  • Prepare dashboards, reports, and analytics 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.
  • Additional certification as a Coder (CPC/CCS/CIC) or other Health Information professional (RHIA/RHIT/CPMA) is required.  CRC or MARSI risk adjustment certification preferred.
  • At least 5 years of experience in Managed Care coding risk adjustment, project management, operations, or quality improvement required.
  • Roughly 2-4 year’s progressive 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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