Who you are:

As the Manager of Medicare Risk Adjustment for the Johns Hopkins’ Medicare Advantage plan, you will lead a team of certified coders in performing audits and coding for the HCC as well as oversee provider education. Your extensive subject knowledge is complemented by your superior communication and problem-solving skills. This makes you the ideal leader, teacher, and coach.

What you’ll do:

• The Manager of Medicare Risk Adjustment (Clinical) will lead a team of certified coders in performing audits and coding for the Hierarchal Condition Categories (HCC) for accuracy, correct documentation, and educational opportunities.
• Oversee provider education by creating and sharing actionable data with providers and driving performance as it relates to risk adjustment.
• Provide critical support in managing the current Medicare Risk Adjustment programs as well as participate in the planning and evaluation of future risk adjustment needs.
• Support the provider partnership and tactics specific to the Medicare Advantage line of business and ensure the day to day execution of risk adjustment initiatives.
• Support the oversight and management of Medicare Advantage risk adjustment activities including vendor management.

What you’ll bring:

• A Bachelor’s degree in Business Management or related field is required. Master’s Degree in related field preferred.
• Work requires a minimum of 5 years’ experience with HCC coding within a health care and/or managed care environment.
• Experience with Medicare and healthcare compliance as it relates to CMS.
• CPC or CRC highly preferred.
• Familiarity with managed care products, risk adjustment, audit and coding, process improvement, organizational development and assessing customer expectations.

Who we are:

Johns Hopkins Health Plans (JHHP) is the managed care and health services business of Johns Hopkins Medicine. JHHP is a $3B business serving over 500,000 active members with lines of business in Medicaid, Medicare, commercial, military health, health solutions, and venture investments. JHHP is a leader in provider-sponsored health plans and is poised for future growth.

Many organizations talk about transforming the future of healthcare, at Johns Hopkins Health Plans, we are setting the pace for change within the healthcare industry. We develop innovative, analytics-driven health programs in collaboration with provider partners to drive improved quality and better health outcomes for our members and the communities we serve. If you are interested in improving how healthcare is delivered, and have a passion to be at the forefront of change, JHHP is the place to call home.

Johns Hopkins Health System and its affiliates are drug-free workplace employers.