Risk Adjustment Solutions Manager (Nationwide Remote)

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Position:
Risk Adjustment Solutions Manager (Nationwide Remote)

Position Summary:
Acts as a subject matter expert and is responsible for developing and facilitating the implementation of new and existing healthcare Quality & Risk Adjustment strategies. Advises other departments and clients on quality & risk adjustment initiatives and provides educational programs; conducts data collection; and reporting and monitoring for key performance measurement activities.

Job Description:

Primary Responsibilities

• Manages a comprehensive Quality and/or Risk Adjustment strategy for our clients by developing data mining strategies, facilitating collection methodology and an effective risk adjustment program, standardizing workflows, ensuring successful completion of internal/external data validations (for RADV Audit), and developing and facilitating implementation of training program for internal and external clients.
• Develops and maintains effective internal and external relationships through effective and timely communication.
• Synthesizes and organizes data, presents information, and provides executive summary of material.
• Maintains accountability for outstanding customer service to all external and internal customers.
• Takes initiative and action to respond, resolve, and follow up with all customers in a timely manner.
• Develops and maintains an expert level of knowledge of Medicare and risk-based reimbursement methodologies.
• Maintains professional and technical knowledge by attending educational workshops, reviewing professional publications, establishing personal networks, and participating in professional societies.
• Manages and improves various department processes.
• Facilitates the development of key performance indicators.
• Presents performance results and findings regularly including the overall RAF score, improvement strategies, and tactics.
• Serves as a subject matter expert for internal and external clients.
• Supports activities of internal RADV monitoring programs and internal and external RADV audits.
• Performs other duties as assigned.

Qualifications

• Bachelor's degree in Health Administration, Business Administration or related field or equivalent
• 5+ years of experience within Healthcare, Health plan, or Health System required, including payer, hospital, Medicaid/Medicare, provider environment or managed care or the knowledge, skills, and abilities to succeed in the role
• Knowledge of Risk Adjustment Payment methodologies and understanding of the CMS HCC, HHS, and Medicaid
• Detail oriented; possesses strong initiative and ability to set priorities
• Ability to successfully manage multiple job functions under pressure with shifting priorities
• Proficiency in Microsoft Office Programs including Word, PowerPoint, Excel, and Outlook
• Excellent organizational capabilities with ability to work effectively as a team player
• Strong aptitude for critical thinking and demonstrated data skills
• Able to manage multiple priorities and deadlines in a dynamic environment
• Excellent interpersonal and communication skills
• Ability to collaborate and work through all professional levels, internally and externally
• Analytical and quantitative problem-solving skills
• Ability to travel up to 30%

Working Conditions

• While performing the duties of this job, the employee works in normal office working conditions.

Disclaimer

• The job description describes the general nature and level of work being performed by people assigned to this job and is not intended to be an exhaustive list of all responsibilities, duties and skills required. The physical activities, demands and working conditions represent those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job duties and responsibilities.

Lumeris is an EEO/AA employer M/F/V/D.

Location:
United States

Time Type:
Full time