Senior Manager, Risk Adjustment

Millennium Physician Group•New York, NY

23h

About The Position

The Senior Risk Adjustment Manager is responsible for conducting the day-to-day management of the team and functions by communicating with other operational departments and provider offices. The Senior Manager will participate in the development, implementation, and performance of workflows for reviewing electronic medical records aimed at improving the health and well-being of patients through the appropriate identification of chronic disease conditions. This role will collaborate with all areas of the organization to ensure the success of our value-based coding initiatives, such as provider engagement, education, prevalence rates, documentation compliance, and medical margin. This includes overseeing and further enhancing the data and reporting model to capture and optimize ICD-10 reporting to payers to improve quality for our patients and reduce healthcare costs.

Requirements

Bachelor’s degree in public health, Healthcare Administration, Business Administration, or a related field from an accredited institution is required.
7+ years of progressive experience in risk adjustment, healthcare consulting, or risk management, specifically within the healthcare sector.
4+ years of proven track record of managing complex projects and leading teams to achieve organizational goals.
Certifications: Certified Risk Adjustment Coder (CRC) and/or Certified Professional Coder (CPC). Additional professional development credentials in healthcare management or risk management are highly desirable.
Demonstrated ability to effectively lead and mentor a diverse team, fostering a culture of collaboration, accountability, and professional development. Experience in developing and implementing departmental policies and procedures in alignment with organizational objectives.
In-depth understanding of healthcare regulations, compliance standards, and risk adjustment methodologies, including Medicare Advantage, Medicaid, and other relevant programs.
Strong analytical and quantitative skills with the ability to interpret data to drive decision-making. Experience with risk adjustment models and quality improvement initiatives.
Proficient in advanced data analysis tools, healthcare analytics software, and Microsoft Office Suite. Familiarity with electronic health records (EHR) systems and coding guidelines (CPT, ICD10).
Excellent verbal and written communication skills with the capacity to present complex information clearly and compellingly to various stakeholders, including executive leadership, clinical teams, and external partners.
Proven experience in managing multiple projects simultaneously while maintaining high attention to detail and meeting deadlines. Ability to adapt to changing priorities in a dynamic healthcare environment.
Strong problem-solving abilities and conflict resolution skills, with a focus on stakeholder engagement and satisfaction.
Willingness to travel as necessary to fulfill professional responsibilities and support strategic initiatives across various locations. Flexibility in working hours to meet the demands of the role.
Ability to work independently in a fast-paced, cross-functional environment.

Responsibilities

Ensure adherence to coding and documentation guidelines, including ICD-10-CM standards, to validate diagnosis codes supported by medical records.
Lead training initiatives for staff to conduct thorough reviews of medical records, recognizing the importance of chronic and major medical condition documentation.
Continuous education for both new and existing team members, focusing on quality improvement in risk coding.
Regularly assess and measure provider performance against key metrics in care and service delivery, aiming for the highest levels of customer satisfaction.
Collaborate effectively with the Risk Adjustment Provider Educator and Support Services for comprehensive provider training.
Maintain clear communication with internal stakeholders regarding the status and results of coding quality reviews.
Compile and present reports to organizational leadership, including revalidation of codes, acceptance and rejection rates, and data trends to identify areas for improvement.
Identify technology solutions that streamline risk adjustment operations and enhance coding accuracy.
Communicate with the IT department to identify flaws in reporting systems, propose performance enhancements, and oversee the tracking and resolution of these issues to ensure optimal revenue capture.
Demonstrate excellent guest service to internal team members and patients.
Perform other related duties as assigned.