Senior Manager, Quality Risk Adjustment – Health Plan/MCO Experienced
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
- Oversee the Quality Risk Adjustment (QRA) Medical Record Review (MRR) program
- Lead and manage the MRR Team, providing guidance, training, and support
- Develop and implement strategic plans to optimize risk adjustment processes
- Manage outsourced vendors to execute operational production plan goals
- Establish and maintain MRR quality assurance protocols
- Conduct regular audits and assessments of MRR team’s work
- Research technological solutions such as AI and NLP for data collection
- Collaborate with Data Science, Sourcing, IT, and other stakeholders
- Identify opportunities for process improvements
- Monitor key performance indicators 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
- Two (2) years experience with implementation and/or development of AI solutions in a healthcare setting 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
- Strong data analytical and problem-solving skills
- Skilled in vendor management, oversight and performance reporting.
Benefits
- Comprehensive total rewards package
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 codingquality managementICD-10 codingHCC risk adjustment modelsCMS regulatory guidelinesAI solutionsdata analysisvendor management
Soft Skills
leadershipguidancetrainingsupportcollaborationproblem-solvingprocess improvementanalytical skills