Medicare Risk Adjustment Manager (Southeast)

CVS Health•Work At Home-Georgia, MS

4d•Remote

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. This is an individual contributor role. As the Manager, Risk Adjustment will be responsible for leading Risk Adjustment for the Southeast Region, specifically in GA/Gulf States. This role will have responsibility in maintaining and improving risk adjustment accuracy by partnering closely with leadership from our key value-based providers. The role drives, in collaboration with the national and local risk adjustment teams, risk coding improvement activities within the region, medical record collection, provider collaboration and data sharing, general coding education and related activities, as well as other activities as assigned. This position requires someone who can think strategically and act independently when working with providers.

Requirements

5+ years of experience with one or more of the following methodologies: risk adjustment, clinical quality, or healthcare quality improvement.
Certification in coding (CPC, CRC, RHIA, etc. through AAPC or AHIMA).
Experience working in provider offices, accountable care organizations and / or value-based provider relations.
Strong time management, project management, change management, organizational, research, analytical, negotiation, communication, and interpersonal skills.
Strong proficiency in Microsoft Office applications (Outlook, Word, Excel, Power Point, etc.), including experience running web-based meetings.
Must be able to manage ambiguity and work in fast paced environment.
Excellent stakeholder relationship management skills.

Nice To Haves

7+ years of experience in risk adjustment, clinical quality, or healthcare quality improvement required; experience supporting provider‑based or value‑based initiatives preferred.
Candidates residing in Georgia or the Southeastern United States are preferred.

Responsibilities

Leading Risk Adjustment for the Southeast Region, specifically in GA/Gulf States.
Maintaining and improving risk adjustment accuracy by partnering closely with leadership from our key value-based providers.
Driving risk coding improvement activities within the region, medical record collection, provider collaboration and data sharing, general coding education and related activities, as well as other activities as assigned.
Thinking strategically and acting independently when working with providers.