Submission for the position: Senior Manager, Risk Adjustment - (Job Number: 1195986)
https://centene.taleo.net/careersection/jobdetail.ftl?job=1195986&lang=en
Senior Manager, Risk Adjustment
Position Purpose: Oversee the risk adjustment coding and data validation programs. Monitor daily queue volumes, prepare executive reports, oversee the coding of risk adjustment audits, develop & support risk adjustment infrastructure and maintain ROI by managing various inputs/outputs.
• Evaluate and manage the risk adjustment strategy across all functional areas that impact assigned products
• Develop and maintain all policy and procedures for departmental processes
• Develop and implement action plans by partnering with all departments affecting assigned products and plans, to address issues identified by the business units, including detailed workplans, issue logs, and progress reports
• Assist in composing provider education for correct coding according to state and federal risk adjustment guidelines
• Work with vendor coding leadership to ensure risk adjustment work being undertaken on behalf of Centene meets all state and federal guidelines for risk adjustment code capture and contractual service level agreements
• Prepare dashboards, reports, and analytics for senior management and identify improvement opportunities
Education and Experience: Bachelor's degree in applicable field or equivalent experience required. 5 years of project management, operations, or quality improvement in the healthcare industry. Experience in risk adjustment or medical record audit preferred. Thorough knowledge of administrative, data management and audit functions. Management/supervisory experience required
Liscense and Certifications: CPC, CPC-H, CPC-P, CCS, CCs-P, RHIA or CPMA required. CRC or MARSI risk adjustment certification preferred.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Claims Operations
USA-Florida-Tampa
USA-Missouri-Clayton
Schedule: Full-time Location(s): USA-Florida-Tampa