Clinical documentation Program Manager
What you’ll do:
- Establishes, develops, and implements Risk Adjustment activities across different Markets to ensure successful execution of Risk Adjustment programs while maintaining programs compliantly.
- Creates & executes out of box thinking/creative way to execution of RA programs.
- Ensures all activities are fully executed through end-to-end process from provider to Centers for Medicare and Medicaid Services (CMS), State and federal regulatory requirements.
- Ensures early detection of major risks and interdependencies for program initiatives across the entire network.
- Combines an in-depth knowledge of Risk Adjustment business, products, and services with a solid understanding of industry trends to develop differentiated solutions to maximize and grow partner relationships.
- Works with stakeholders across the system to ensure effective coordination.
- Provides updates to Risk Adjustment Stakeholders on program operational activities – creates dashboards and operational metrics to demonstrate program success.
- Manages activity of cross-functional teams to help support reporting capabilities.
What you’ll need:
- Bachelor’s degree in related field of study preferred. Advanced Degree preferred or an equivalent combination of education and experience.
- 5+ years of experience with Risk Adjustment/HCC Payment Methodology
- 5+ years of experience working for a Health Plan/payor including 3+ years of experience in project management
- Solid knowledge and understanding of Payor, ACO, Medicare/Medicaid, End to End cycle for Risk Adjustment.
- Must be a strategic thinker, open minded, with a high level of intellectual curiosity and openness to change as well as excellent verbal and written skills.
- Proven ability to perform complex business analysis and decision-making, outstanding presentation and communication skills with the ability to effectively analyze and synthesize large amounts of complex data in relevant insights.