Risk Adjustment Manager

RISK ADJUSTMENT MANAGER

 


SUMMARY

Create, manage and implement risk adjustment projects and coding team to obtain accurate reimbursement for Medicare Advantage membership.  Help Monarch physician partners succeed in the Medicare Advantage HCC Risk Adjustment payment model.

 

ESSENTIAL DUTIES AND RESPONSIBILITIES: Lead the development and implementation of risk adjustment tools for the provider network.Evaluate risk adjustment information given by health plans and decide course of action needed from information given. Monitor and evaluate risk adjustment progress.Work with functional areas which may assist in improving Monarch?s overall risk score.Manage coding team and ensure coding compliance with the provider network.  Establish a team culture focused on bringing value to the provider network with this new payment system, through risk adjustment tools creation, coding audit services and educational reimbursement workshops.  Assist in Risk Adjustment revenue projections Assist in Risk Adjustment revenue reconciliationManage outside vendors when neededBe the Subject Matter Expert in the company regarding risk adjustment.Keep abreast with CMS rules, regulations and rates, as it pertains to the Medicare Advantage payment system; communicate these changes to affected departments.Assist in the collection and analysis of qualitative and quantitative data as it relates to risk adjustment.Synthesize and mine data sets for risk adjustment analysis and identifies key finds for areas of coding or clinical practice improvement. Works closely with senior management to ensure that strategic goals are met in regards to risk adjustment.Educate and inform internal staff regarding risk adjustment payment model. 


POSITION REQUIREMENTS:
Previous experience in the areas of reimbursement methodologies required/risk adjustment payment methodology preferred. Individual must be open minded and able to work with all levels of professionals.  Individual must be highly analytical and possess critical thinking skills.  Individual must have excellent listening and communication skills.  Individual must be able to create and implement project plans.  Individual must possess leadership skills.