The Risk Assessment Program Manager will help establish, develop, and maintain key operational initiatives to drive Clinical Documentation Program activities. This role will be responsible for the execution of Value Based campaigns, managing deadlines, working with providers and practices in execution of program activities. The Risk Assessment Program Manager is a valued thought leader, who will be responsible for facilitating and driving the definition and prioritization of complex risk adjustment improvement strategies.

The work you will 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.

The skills and qualifications you need:

• 5+ years of experience with Risk Adjustment/HCC Payment Methodology
• 5+ years of experience working for a Health Plan/payor
• 3+ years of experience in project management
• Bachelor’s degree in related field of study preferred.
• Advanced Degree preferred or an equivalent combination of education and experience.
• Demonstrates ability to expertly navigate a variety of software applications.
• Solid knowledge and understanding of Payor, ACO, Medicare/Medicaid, End to End cycle for Risk Adjustment.
• Ability to come in with an open mind, a starters mindset and able to navigate through ambiguity.
• Must be a strategic thinker, with a high level of intellectual curiosity and openness to change.
• Proven ability to perform complex business analysis and decision-making, with the ability to effectively analyze and synthesize large amounts of complex data in relevant insights.
• Outstanding presentation and communication skills, ability to prepare and deliver presentations that convey critical information while being able to adjust, as necessary to meet the needs of the audience.
• Excellent verbal and written skills, ability to interact well with both internal and external stakeholders.