Senior Manager, Quality Risk Adjustment
CareSource
full-time
Posted on:
Location Type: Remote
Location: United States
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Salary
💰 $113,000 - $197,700 per year
Job Level
About the role
- Overseeing the Quality Risk Adjustment (QRA) Medical Record Review (MRR) program
- Lead and manage the MRR Team
- Develop and implement strategic plans to optimize risk adjustment processes
- Manage outsourced vendors to execute operational production plan goals
- Work with QRA Compliance Team to establish and maintain MRR quality assurance protocols
- Conduct regular audits and assessments of MRR team’s work
- Research technological solutions such as the use of AI and NLP
- Collaborate with various teams to deploy AI/NLP solutions
- Improve insourced retrieval and outsourced vendor work flows
- Develop and implement training programs for staff
- Monitor key performance indicators (KPIs) related to risk adjustment and quality metrics
Requirements
- Bachelor's degree in Health Administration, Healthcare Management, or a related field is required
- Master's degree is preferred
- Seven (7) years experience in risk adjustment medical record review program management, medical coding, or quality management in a healthcare setting required
- Three (3) years of leadership experience required
- Knowledge of ICD-10 Coding
- Knowledge of HCC Risk Adjustment models
- Knowledge of CMS regulatory guidelines
- Ability to utilize AI Technologies and their applications in healthcare data management and analysis
- Skilled in vendor management, oversight and performance reporting
Benefits
- Comprehensive total rewards package
- Health insurance
- Bonuses tied to company and individual performance
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
risk adjustmentmedical record reviewmedical codingICD-10 codingHCC risk adjustment modelsCMS regulatory guidelinesAI technologiesNLPperformance reportingquality management
Soft Skills
leadershipteam managementstrategic planningcollaborationtraining developmentauditingcommunicationvendor managementproblem-solvingmonitoring KPIs