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Senior Manager, Medical Risk Adjustment Analytics
CareSourceSenior Manager, Medical Risk Adjustment Analytics managing day-to-day risk adjustment operations for member health profiles. Overseeing processes for Medicare, Medicaid and ACA/Marketplace compliance and documentation.
Tech Stack
Tools & technologiesSQL
About the role
Key responsibilities & impact- Responsible for the day-to-day operations of the risk adjustment function across all lines of business
- Analyzes member information to ensure the Risk Adjustment Factor accurately reflects the membership health profile
- Develops and implements processes and procedures to ensure the accuracy and completeness of the Medicare Risk Adjustment, Medicaid and ACA/Marketplace data
- Analyzes and monitors clinical Risk Adjustment reports
- Supports the development of monthly revenue accruals and forecast related to the risk adjustment activities
- Oversees and monitors data submission for attestation to CMS for Risk Adjustment
- Recruits, develops, and motivates staff
Requirements
What you’ll need- Bachelor of Science degree in Finance, Business Administration, or Clinical related field or equivalent work experience is required
- Seven (7) years of experience in analyzing health care claims data and/or risk scores, to include database experience (SAS, SQL, or Access), required
- Three (3) years of management/supervisory experience required
- Experience in communicating and presenting to senior leadership preferred
- Knowledge of health care reporting standards preferred
- Managed care or healthcare experience is preferred
- Expert proficiency level with Microsoft Excel
- Knowledgeable of Medicare/CMS Risk Adjustment regulations
- Knowledgeable of ICD-10 and CPT codes
- Ability to manage, develop, motivate and reward professional staff
- Excellent oral and written communication skills
Benefits
Comp & perks- bonuses tied to company and individual performance
- substantial and comprehensive total rewards package
ATS Keywords
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Hard Skills & Tools
SASSQLAccessMicrosoft ExcelICD-10CPT codesdata analysisrisk adjustmenthealth care claims analysisrevenue forecasting
Soft Skills
managementsupervisory experiencecommunication skillspresentation skillsstaff developmentmotivationleadershiporganizational skillsinterpersonal skillsteam building