Risk Adjustment Revenue Manager (Remote)

Sanford Health • Marshfield, WI

6d • Remote

About The Position

The Risk Adjustment Revenue Manager is responsible for risk adjustment strategy and related revenue management for Security Health Plan’s Medicare, Affordable Care Act and Medicaid business. This individual provides development and implementation of programs and initiatives to improve the accuracy of the coding, including education; retrospective and prospective review processes; and vendor contract management; accountability for preparation for and management of the Centers for Medicare and Medicaid Services (CMS) and the Department of Health Services (DHS) auditing processes; management of encounter data processes; and management of applicable state and federal guidance. The Risk Adjustment Revenue Manager works collaboratively with Security Health Plan executives and leadership as well as Marshfield Clinic Health System (MCHS) executives and leadership to lead risk adjustment strategy and process.

Requirements

• Bachelor’s Degree in Business Administration, Finance, Health Care Administration, Management or related field required.
• Five years of experience in risk adjustment or related area.
• Three years of experience in a management or leadership role and experience in the healthcare industry.
• Demonstrate a broad understanding of healthcare and health insurance.
• Demonstrate proficiency with verbal and written communication, strategic planning and business acumen.
• Certifications in professional coding and risk adjustment coding from American Academy of Professional Coders.
• State of Wisconsin driver’s license with an acceptable driving record.
• Employee may not at any time have been or be excluded from participation in any federally funded program, including Medicare and Medicaid. This is a condition of employment. Employee must immediately notify his/her manager or the Health System’s Compliance Officer if he/she is threatened with exclusion or becomes excluded from any federally funded program

Nice To Haves

• Post graduate degree(s) desirable.
• Working knowledge of CMS and/or Medicaid risk adjustment methodologies.

Responsibilities

• Development and implementation of programs and initiatives to improve the accuracy of the coding, including education
• Retrospective and prospective review processes
• Vendor contract management
• Accountability for preparation for and management of the Centers for Medicare and Medicaid Services (CMS) and the Department of Health Services (DHS) auditing processes
• Management of encounter data processes
• Management of applicable state and federal guidance
• Works collaboratively with Security Health Plan executives and leadership as well as Marshfield Clinic Health System (MCHS) executives and leadership to lead risk adjustment strategy and process.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees