Regional Manager, Risk Adjustment

Position Summary:

The Regional Manager of Risk Adjustment will be accountable for successfully managing the Risk Adjustment program across multiple markets or RBE’s (Risk Bearing Entities) by collaborating, supporting, and engaging with their provider partners and their practices. This person will work across multiple operational teams to develop or improve systems, processes and tools that will help with the scheduling of patients, identification of diseases, assessment of the diseases and care gaps with proper documentation to ensure accurate submission of information to health plan entities.

Essential Job Functions:

• Outcome owner of multiple markets Risk Adjustment KPI’s

• Responsible for Provider engagement and education related to Risk Adjustment.

• Engages with Providers and their office staff by sharing performance data that is actionable.

• Leads operational efforts for improvements by addressing variability and highlighting performance opportunities.

• Assists with developing optimal provider practice workflows.

• Collaborates with platform Coding and Prospective teams on the performance of those programs within their markets.

• Accountable for hiring, onboarding and the ongoing management of market Risk Adjustment team members (Program Managers, Coordinators, etc.)

• Responsible for team assignments, workload, and performance management • Leads, facilitates, and presents at market Risk Adjustment meetings.

• Participates in the orientation of market team members, new providers and/or practice groups by educating them to the Risk Adjustment program.

• Assist and supports Regional Risk Adjustment Director or designated Market Leader on projects as needed. • Ability to travel between multiple locations and practices.

• All other duties as assigned.

Other Job Functions:

• Understand, adhere to, and implement the Company’s policies and procedures.

• Provide excellent customer services skills, including consistently displaying awareness and sensitivity to the needs of internal and/or external clients. Proactively ensuring that these needs are met or exceeded.

• Take personal responsibility for personal growth including acquiring new skills, knowledge, and information.

• Engage in excellent communication which includes listening attentively and speaking professionally. • Set and complete challenging goals.

• Demonstrate attention to detail and accuracy in work product.

Qualifications:

Minimum Experience:

• 6+ years, of experience in managed care or the health care industry

• Experience with managing multiple markets/regions

• Value Based Care experience preferred.

• 4 + years people Management experience

• Experience with Program Management

• Must be able to interpret data.

Education/Licensure:

• Bachelor’s degree: or equivalent work experience required.

• Certified Coder preferred (CCS, CCS-P, CPC CRC)

Salary range shown is a guideline. Individual compensation packages can vary based on factors unique to each candidate, such as skill set, experience, and qualifications.