Director, Risk Adjustment
Centene Corporation
full-time
Posted on:
Location Type: Remote
Location: California • Illinois • United States
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Salary
💰 $118,400 - $219,000 per year
Job Level
About the role
- Director, Risk Adjustment responsible for driving Risk Adjustment for various lines of business and achieving related revenue targets
- Identify opportunities to improve completeness and accuracy of risk adjustment data submitted to CMS and HHS
- Develop, analyze and report key risk adjustment metrics
- Oversee analyses of new legislation and regulations regarding Risk Adjustment and assess impact on programs
- Partner with executive leadership to plan strategic direction of Risk Adjustment initiatives
- Evaluate and oversee development and implementation of CMS and HHS risk adjustment program changes
- Incorporate changes and requirements into strategy
- Coordinate with functional areas including Medical Management, Quality, Pharmacy, Operations, etc.
- Use analytics to define Risk Adjustment focus
- Identify areas to increase quality and maximize opportunities
- Direct development of key analytics and data to support Risk Adjustment forecasts and reporting
- Educate stakeholders on changes in regulations and recommend areas of process improvement
- Maximize ROI in Risk Adjustment operations by reducing reliance on vendors
- Maintain effective and optimal Risk Adjustment submission process and Quality Assurance Program
- Monitor, measure and communicate Risk Adjustment performance and submission quality
- Develop performance targets for constituents and track progress against stated goals
- Serve as subject matter expert in projects and initiatives
- Drive Risk Adjustment best practices across all lines of business
- Develop and implement employee training and provider outreach programs as needed
Requirements
- Must possess a Bachelor’s Degree from an accredited college or university
- Preferred field of study: business, math, finance, economics, actuarial science, healthcare administration or other related health care field
- Position requires at least two years of experience with Risk Adjustment
- Experience at a Manager or Director level is preferred
- Experience with actuarial, finance and/or operational activities of a health plan
- Demonstrated success in improving Risk Adjustment measures
- Demonstrated success leading cross-functional teams
- Ability to prioritize tasks with competing deadlines
Benefits
- competitive pay
- health insurance
- 401K and stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- flexible approach to work with remote, hybrid, field or office work schedules
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
risk adjustmentdata analysisperformance metricsanalyticsquality assuranceprocess improvementforecastingreportinglegislation analysisprogram development
Soft Skills
leadershipstrategic planningcommunicationcollaborationprioritizationstakeholder educationteam managementproblem-solvingadaptabilitytraining development