Risk Adjustment Strategic Manager
| Company | Elevance Health |
|---|---|
| Location | Indianapolis, IN, USA, Tampa, FL, USA, Richmond, VA, USA, Mason, OH, USA, Atlanta, GA, USA |
| Salary | $Not Provided – $Not Provided |
| Type | Full-Time |
| Degrees | Bachelor’s |
| Experience Level | Senior |
Requirements
- Requires a BA/BS in a related field and minimum of 5 years of experience in a managed care setting with extensive risk adjustment experience with a focus on CMS audit experience; or any combination of education and experience, which would provide an equivalent background.
Responsibilities
- Assists management by overseeing day to day operations for risk adjustment programs including both prospective and retrospective, claims, vendor quality, and audits
- Develops metrics, policies, and procedures in support of required deliverables and validation of programs return on investment while ensuring the programs are in compliance with Center for Medicare and Medicaid Services (CMS) program requirements
- Serves as a strategic partner to the business and contributes to ideas and solutions
- Influences others and works effectively to establish and develop working relationships both internally and externally with business stakeholders
- Obtains and complies trend data and educates providers
- Collaborates with the operations risk and compliance teams in implementing and deploying Enterprise Risk and Compliance initiatives, processes, and tools
- Effectively drives remediation of risks and issues by collaborating with Business Operations, Internal Audit and Regulatory Compliance
- Finds root cause and recommends innovative solutions
- Provides oversight and ensures complete and accurate coding for Medical Revenue Management programs driving the revenue we receive from CMS
- Leads and consults with operations on ad hoc requests/special projects
- Works collaboratively with Enterprise Risk Adjustment team, Business Operations, Regulatory Compliance, and Internal Audit
Preferred Qualifications
- MBA/MHA in Healthcare Administration Preferred
- Experience working with Health Insurance payer side of business strongly preferred
- Strong understanding of Health insurance Claims processing preferred
- Experience working directly with providers and or provider group leadership strongly preferred
- Executive Communication skills is a must
- Moderate to advanced experience in Excel and Tableau preferred