RISK ADJUSTMENT MANAGER

Toledo Clinic • Toledo, OH

5h

About The Position

This position is accountable for the successful performance of The Toledo Clinic’s Risk Adjustment programs in its Value-Based programs through close collaboration, support, and engagement with Providers and practice teams. The role partners with cross-functional operational teams to enhance systems, processes, and tools that support accurate disease identification, assessment, and closure of care gaps, ensuring compliant documentation and accurate submission of Risk Adjustment data.

Requirements

• Minimum Qualifications: Bachelor’s degree or 6+ years equivalent work experience in managed care or the health care industry.
• Consistently arrives at work, in professional attire, on time and completes all tasks within established time frame.
• Seeks appropriate tasks when primary tasks are completed and assists co-workers as needed.
• Demonstrates adaptability to expanded roles.
• Adheres to clinic’s policies and procedures.

Nice To Haves

• Value Based Care experience and Certified Coder (CCS, CCS-P, CPC CRC) preferred.

Responsibilities

• Leads provider engagement and education relative to Risk Adjustment, including accurate documentation, coding specificity, and compliance with CMS and payor requirements.
• Partners with Providers and practice staff to share actionable performance data and translate insights into workflow improvements.
• Drives operational improvement efforts by identifying variability in documentation and RAF capture and highlighting performance opportunities.
• Collaborates with clinical, coding, quality, and analytics teams to develop and optimize provider workflows that support compliant risk adjustment outcomes.
• Supports onboarding and orientation of new Providers and practice groups by educating them on Risk Adjustment processes, expectations, and benchmarks.
• Monitors Risk Adjustment performance and the provider and practice level and ensure timely follow-up on identified gaps and trends.
• Ensures alignment and compliance with CMS, Medicare Advantage, and payor-specific Risk Adjustment guidelines, supporting audits and retrospective reviews as needed.
• Travels between multiple practice locations to support in-person provider engagement and operational needs.
• All other duties as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Number of Employees: 251-500 employees