Manager, Risk Adjustment

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

📋 Description

• Oversee business processes associated with risk adjustment and quality enhancement for designated products and plans.

• Formulate and implement strategic action plans across various departments to resolve business-unit challenges.

• Develop comprehensive work plans, issue trackers, and progress updates.

• Collaborate with departments to fulfill business requirements for designated products.

• Create and implement operational workflows customized to product specifications, competitive environments, and local market conditions.

• Assess and manage risk adjustment strategies across functional areas affecting designated products.

• Identify and assist with health plan initiatives related to assigned products.

• Generate dashboards for senior management while pinpointing opportunities for improvement.

• Guide a team of 7 direct reports located in AZ and NV.

⛳️ Requirements

• One of the following certifications is required at the time of hire: CPC, CPC-H, CPC-P, CRC, CCS, CCS-P, RHIT, RHIA, or CPMA.

• CRC certification is required within the first year of employment.

• CPMA certification is preferred in the second year of employment.

• Proven ability to lead a team of 7 direct reports in AZ and NV.

• Excellent analytical skills.

• Capability to multitask and adapt quickly.

• Strong knowledge of coding and risk adjustment programming.

• Exceptional presentation skills, particularly with leadership and provider networks.

• Bachelor’s degree in a related field or equivalent experience.

• At least 4 years of experience in project management, operations, quality improvement, or data analysis/reporting within the healthcare sector.

• Prior experience in managed care or Medicare is preferred.

🏝️ Benefits

• Competitive compensation.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase options.

• Tuition reimbursement programs.

• Paid time off in addition to holidays.

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

• Additional incentives may be included in the overall compensation package.

• Commitment to equal opportunity and diversity.