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Leads the development, analysis and reporting of key risk adjustment metrics, as well as oversees analyses of new legislation and regulations regarding Risk Adjustment and assessing the impact of any changes to the programs. Maximizes revenue strategies for VNS Health Plans. Coordinates multiple cross functional activities and projects related to risk adjustment across all departments as well as interactions with external vendors. Oversees the performance of the person(s) and vendors in charge of chart audits, home visit assessments and the performance of internal resources devoted to the Hierarchical Condition Category/Risk Adjustment Factor (HCC/RAF) efforts. Collaborates with the data science and business intelligence teams to determine potential data analytics initiatives with the focus on improving operations to improve risk score accuracy. Works under general direction.
Compensation:$193,600.00 - $258,200.00 Annual
What We Provide
What We Provide
What You Will Do
Education:
Bachelor's Degree in Business Administration, Finance, Health Care Administration, or other related field required
Master's Degree in Business, Health Administration, Health Policy or related discipline preferred
Work Experience:
Minimum eight years of progressively responsible experience in health insurance industry with specific experience in risk adjustment required
Demonstrated working knowledge of Medicare Risk Adjustment methodology, Medicare payment policies, coding and documentation practices, and process improvement and optimization techniques required
Strong understanding of healthcare operations,encounter and risk adjustment data and the ability to analyze, identify gaps and recommend strategic initiatives for revenue maximization required
Operational knowledge of provider relations, claims, and medical management required
Full Time
$228k-329k (estimate)
04/23/2024
06/22/2024