What are the responsibilities and job description for the Risk Adjustment Program Lead position at SIHO Insurance Services?
Job Title: Risk Adjustment Program Lead
Reports To: Vice President, MyTruAdvantage
The primary responsibility of the Risk Adjustment Program Lead is to serve as the subject matter expert for risk adjustment, maintaining oversight of all risk adjustment activities. This role will support Medicare Advantage and ACA risk adjustment programs.
*Ideal candidates would be located in Indiana or surrounding states.
Brief Description of Duties:
- Serve as the expert on Medicare Risk Adjustment models; monitor regulatory changes, ensuring adherence to CMS/HHS guidelines
- Develop and monitor metrics and KPIs to track the success of solutions and improvements; develop dashboards to share risk adjustment trends to key stakeholders; communicate risk adjustment impacts across all levels of the company
- Conduct comprehensive research and analysis to identify trends and areas of opportunity related to risk adjustment; contribute to the development and implementation of strategic initiatives and a risk adjustment work plan; collaborate with plan partners to leverage a lean team and all possible resources to improve risk adjustment outcomes
- Responsible for forecasting revenue and collaborating with finance team
- Create and maintain department policies and procedures
- Ensure plan readiness and compliance for RAD-V and CMS audits
- Own vendor oversight of data integration and coding accuracy for Encounter Data Submissions and risk analytics
Qualifications
Minimum Skills Requirement:
- Minimum of 5 years of experience in Medicare risk adjustment
- Strong knowledge of CMS risk adjustment models/methodologies and HCC coding
- Strong analytical, organizational, problem-solving, vendor management, and critical thinking skills
- Ability to work independently and manage multiple projects involving cross-functional teams and external vendors
- Ability to interpret and analyze complex data and translate this into meaningful, actionable information
- High standards of quality and accuracy
- Advanced skills in Microsoft Excel
- Commitment to maintaining confidentiality in compliance with HIPAA