What are the responsibilities and job description for the Medicare Risk Adjustment Program Manager position at Independent Health?
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Overview
The Medicare Risk Adjustment Program Manager will be accountable for the organization, communication and execution of specific HCC risk adjustment activities supporting the Medicare line of business. They will manage the development and implementation of successful activities that improve the accuracy of the CMS risk adjustment scores of the Medicare Advantage membership. This role will facilitate appropriate communications and interface among the Medicare Product, Compliance, and Coding Integrity areas to lead Medicare HCC risk adjustment regulatory requirements and ensure program deliverables are achieved on time.
The Medicare Risk Adjustment Program Manager will be accountable for the end-to-end management, delivery and support to new and existing Risk Adjustment programs through development, documentation, tracking and reporting of deliverables. This will include detailed work plan development, coordination of provider chart requests, internal communications and meetings, coding team coordination, milestone tracking, development of operational policies and procedures, quality assurance metric gathering and weekly communication of status updates with key stakeholders.
Qualifications
- Bachelor’s degree required. An additional four (4) years of experience will be considered in lieu of degree.
- Four (4) years of experience working with government agencies including the Centers for Medicare & Medicaid Services (CMS) and Medicaid Inspector General (OMIG) required. Other regulatory experience may be considered in lieu of the above if applicable.
- Ability to lead regulatory business and technical based initiatives to a successful outcome.
- Experience in project management including the definition of project plans and tracking specific tasks is required.
- Understanding of regulatory requirements as they relate to Medicare Advantage HCC risk adjustment.
- Skill in organizing resources and establishing priorities.
- Strong interpersonal and communication skills and the ability to work effectively with a wide range of associates across multiple business areas.
- Ability to effectively work and build relationships in matrix environment.
- Local travel may be required. Must have a reliable means of transportation. Any Independent Health associate who uses a motor vehicle in the course of their duties representing Independent Health must be compliant with State Motor Vehicle laws and must follow the Policy that pertains to Driver’s License Requirements as a condition of employment.
- Proven examples of displaying the IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable.
Essential Accountabilities
- Manage Medicare risk adjustment program operations that require coordination with various departments to ensure regulatory requirements are met.
- Develop short-term and long-term strategies to meet risk adjustment accuracy goals and requirements.
- Evaluate risks to risk adjustment programs goals and objectives and escalate as appropriate.
- Lead and manage project team members and/or external consultants by implementing and managing changes and interventions to ensure project goals are achieved.
- Lead the day-to-day execution of Strategic Risk Adjustment Program engagements taking ownership of the engagement deliverables, resources, and outcomes.
- Ensure accurate, compliant, and timely distribution of project milestones and tasks required to meet stated goals.
- Lead and/or participate in decision-making efforts providing project tracking and documentation retrieval.
- Work with Provider Engagement and external provider partners to obtain medical chart documentation in an expedited fashion.
- Develop, communicate, manage and monitor an overall program work plan throughout the implementation of an annual review program with reporting dashboards.
- Coordinate program deliverables and tasks across various departments, ensure milestones are on track to meet initiative parameters.
- Identify risk adjustment process improvement/redesign opportunities; document and redesign business processes as appropriate as well as facilitate process change.
- Support quality assurance measurement activities as necessary.
- Work with cross functional business owners, stake holders, and government entities to ensure all required measures are achieved.
Immigration or work visa sponsorship will not be provided for this position
Hiring Compensation Range: $75,000 - $90,000 annually
Hiring Compensation Range: $75,000 - $90,000 annually
Compensation may vary based on factors including but not limited to skills, education, location and experience.
In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off. The base salary range is subject to change and may be modified in the future.
As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant’s race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law.
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Current Associates must apply internally via the Job Hub app.
Salary : $75,000 - $90,000
