Job Summary:
The Manager, Medical Risk Adjustment Programs & Operations is responsible for managing performance, activities and SLAs of outside vendors who are partnered with for risk adjustment interventions. For candidates within 45 minutes of the Dayton OH area, this position will be hybrid. Outside the region is remote.
Essential Functions:
- Operates in a matrix environment influencing and managing collaborative risk adjustment initiatives with other internal functional groups.
- Manages day to day operations of internal Risk Adjustment retrospective efforts including staff production and quality standards.
- Aids in developing strategy, program design and refinement of risk adjustment retrospective initiatives and operations.
- Develops and maintains documentation of Risk Adjustment processes.
- Set, achieve and maintain Medical Record Retrieval goals.
- Manage vendor relationships and accountability.
- Understanding of Medicare, Medicaid and ACA lines of business and RADV processes.
- Maintain excellent understanding of all CMS requirements and directives for Risk Adjustment to ensure processes are compliant with all applicable laws and regulations.
- Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions including employment, termination, performance reviews, salary reviews, and disciplinary actions.
- Perform any other job duties as requested.
Education and Experience:
- Bachelor of Science degree in Finance, Business Administration or related field or equivalent work experience is required
- Five (5) years of experience in managed care and/or Risk Adjustment required
- Two (2)years of management/supervisory experience preferred
Competencies, Knowledge and Skills:
- Knowledgeable of Medicare/CMS regulations
- Knowledgeable of ICD-10 and CPT codes
- Effective oral, written and interpersonal communication skills
- Process improvement and process management
- Ability to manage, develop, motivate and reward professional staff
- Ability to effectively report data, analyze facts, and exercise sound business judgment when making recommendations
- Ability to analyze problems, draw conclusions, develop processes & communicate status and results
- Ability to work independently
- Critical listening and thinking skills
Licensure and Certification:
Working Conditions:
- General office environment; may be required to sit or stand for extended periods of time
Compensation Range:
$90,500.00 - $158,400.00
CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Salary
Organization Level Competencies
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer, including disability and veteran status. We are committed to a diverse and inclusive work environment.