Director, Risk Adjustment Program
Capital Blue Cross
full-time
Posted on:
Location Type: Remote
Location: Pennsylvania • United States
Visit company websiteExplore more
Salary
💰 $118,650 - $223,560 per year
Job Level
About the role
- Actively monitor performance, productivity, and staff development activities.
- Lead and oversight Risk Adjustment functional areas driving optimal outcomes: Chart Retrieval, Coding (including Coding Quality/HCC Compliance), Analytics/Reporting, and Encounter Data Submissions serving Retrospective and Prospective Programs.
- Guide and oversees the creation, implementation, and monitoring process of the Risk Adjustment Program strategy, objectives, tactics, and initiatives to drive a year over year quality of care improvements, appropriate reimbursement, and compliance with CMS mandates, regulations, and audits.
- Lead oversight of Risk Adjustment vendors.
- Lead in the identification, evaluation, and management of risk adjustment vendors. RFPs readiness, potential vendors evaluation, selection, project implementation, etc.
- Implement a governance structure that provides significant oversight and audit readiness.
- Collaborate with the Government Program Compliance Officer to develop, execute and continually refine a quality assurance program to monitor, audit and improve the CBC Risk Adjustment Program.
- Develop and implement remediation strategies as needed with individual providers, provider groups, internal teams, etc.
- Support and guide business decisions, inform financial plans/forecast, bids development, risk adjustment activities and revenue optimization strategies.
Requirements
- 7 years experience working with Medicare Advantage Plans experience
- 5 years experience overseeing and leading Risk Adjustment Program
- 3 years experience building and leading efficient operations and successful teams
- 5 years of management experience highly preferred
- 3 years experience of budget administration
- Bachelor’s degree in business administration, Health Management/Administration, Data Analytics, Data Science, Finance, Actuarial, Mathematics or Statistics, Public Health or Health-related Sciences; or additional 4 years of relevant experience in lieu of degree
- Certified Risk Adjustment Coder Certification is preferred.
Benefits
- Health insurance
- 401(k) matching
- Paid time off
- Remote work options
- Professional development opportunities
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
Risk AdjustmentCoding QualityHCC ComplianceAnalyticsReportingEncounter Data SubmissionsBudget AdministrationRemediation StrategiesQuality AssuranceGovernance Structure
Soft skills
LeadershipCollaborationOversightStaff DevelopmentStrategic PlanningCommunicationEvaluationManagementDecision MakingProblem Solving
Certifications
Certified Risk Adjustment CoderBachelor’s Degree