Senior Manager, Risk Stratification Operations, Remote
Bethesda, MD
Provider Networks – Network Operations & Performance /
Full Time /
Remote
The Senior Manager of Risk Adjustment is responsible for leading programs and processes and achieving success in the domain of complete and accurate diagnosis documentation and risk adjustment. This includes working across teams in a collaborative effort to reach organizational goals.
Primary Duties:
- Lead or coach process owners and improvement teams in optimizing accurate coding, billing, documentation. Acting as the liaison for multiple teams in a matrixed environment. This includes collaboration with clinical, market teams and compliance/legal.
- Responsible for risk payer relationships. They will eventually lead the team who is responsible for tracking all diagnosis submissions through the entire risk process and our overall workflow.
- Work with payer to promote risk programs.
- Own reporting for meetings with payer leaders for our working groups related to work with Risk.
- Oversee development for reporting for all stages of the risk adjustment process.
- Work with BI and Impact Analytics to determine impact of various interventions.
- Serve as a key Business Stakeholder and RA subject matter expert for the BI and Analytics team.
- Act as the liaison with the analytics team to discuss risk trends the team has observed; understand patterns and assist with analytical interpretation.
- Collaborate and support the performance team with operational execution.
- Develop strategies and tactics to improve risk adjustment accuracy through technology/product and program enhancements.
- Work with internal and external stakeholders on projects and programs.
Minimum Qualifications:
- Bachelor’s degree in Healthcare Adm or Business (or appropriate equivalent training)
- 5+ years payer/healthplan/value based care company including Medicare and Commercial
- 5 + years risk adjustment including Medicare, MSSP
- Demonstrated knowledge and experience with risk adjustment methodologies such as HCC, 3M, Milliman, etc.
- 5+ years of program management, project leadership and execution experience in a healthcare or product related setting.
- 5+ years of management experience
- Strong data analytics skills
- Proficiency in Microsoft Office, Project/Product management, Google Suite
Preferred:
- MBA, MHA or other Master’s level training in health, business or IT
- 5+ years of program management, project leadership and execution experience in a healthcare or product related setting.
- Demonstrated leadership ability in prior workplace, including running teams and managing high import portfolio, with internally and externally facing representation responsibilities
- Advanced Microsoft Office, Project/Product manage, Analytics: SQL, PowerBI, SAS
