Manager, Compliance Risk Adjustment

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee a team dedicated to facilitating and managing external audits relating to Risk Adjustment processes.

• Ensure transparency by reporting on audit deliverables and the associated risks for every audit.

• Work collaboratively with various business areas to identify, prevent, and rectify compliance issues discovered during external audits.

• Act as the primary contact for external audits, communicating with auditors regarding acknowledgments, timelines for deliverables, and any inquiries.

• Manage the submission of external audit deliverables and respond promptly to requests from state and federal regulatory agencies.

• Conduct quality reviews of external audit deliverables to ensure completeness and accuracy before they are submitted.

• Liaise with both internal and external audit partners to clarify deliverables, requirements, and deadlines.

• Function as a subject matter expert on external audit processes, policies, and initiatives aimed at quality improvement.

• Share identified risks with internal partners and input them into the Corrective Action Intake system.

• Assist in the development and review of Corrective Action Plans prior to submission to external auditors.

• Maintain comprehensive audit documentation, which includes meeting minutes, action items, identified issues, and risk management plans.

• Prepare and deliver reports to stakeholders regarding the performance and progress of risk adjustment audits.

• Contribute to strategy development focused on enhancing risk adjustment accuracy and operational efficiency.

• Provide operational and analytical support to the Risk Adjustment department.

• Research and suggest best practices for ongoing improvements in risk adjustment.

• Execute additional duties as assigned.

• Adhere to all policies and standards.

⛳️ Requirements

• Bachelor's Degree in Audit, Compliance, Legal, or a related field, or equivalent experience is required.

• A minimum of 5 years of experience in Audit, risk adjustment, and/or compliance is required.

• Prior experience in oversight of risk adjustment and/or coding planning is preferred.

• Proven understanding of the risk adjustment regulatory landscape is preferred.

• Experience with risk adjustment regulatory audits is preferred.

• Medicare experience is preferred.

• An active Coding Credential from AHIMA or AAPC is preferred.

• CPMA, RHIA, RHIT, or Risk Adjustment Credential is preferred.

🏝️ Benefits

• Competitive pay.

• Health insurance.

• 401K plan.

• Stock purchase plans.

• Tuition reimbursement.

• Paid time off plus holidays.

• Flexible work arrangements including remote, hybrid, field, or office schedules.

• Additional forms of incentives may be included in total compensation.

• Equal opportunity employer committed to diversity.