Risk Adjustment Performance Manager Jobs in Arkansas

Strong clinical knowledge related to chronic illness diagnosis, treatment and management

100% REMOTE - Work from home

Long term contract position- Benefits Offered!

What other skills/experience would be helpful to have?

Remain current on diagnosis coding guidelines and risk adjustment reimbursement reporting requirements

Active certified coder certification (CRC, CPC, CCS - P) through AHIMA or AAPC

Support your manager by guiding decisions on an ongoing basis

3+ years of experience in Healthcare Operations

2+ years of experience with being held to and accomplishing goals

Experience / background in a fast-paced operations environment

Experience managing several critical, deliverables simultaneously

Maintain a strong grasp of our inventory and deliverables to ensure we are keeping/exceed pace against goal

Research to maintain a working knowledge of the RA regulations; interpret and apply the requirements across the enterprise.

Professional Academy of Healthcare Management (PAHM)

Work with other department leaders/managers to ensure risk adjustment (RA) compliance is monitored and practices are following industry standards.

Bachelor’s Degree or 4 years commensurate work experience.

3+ years’ experience in health plan RA compliance, regulatory affairs, government affairs, or a similar field..

Prior experience working with regulators on RA audits, compliance audits, reporting and other matters.

Five-plus years of provider education experience

Monitor provider documentation after education; re-educate as needed

Prepare formalized reports from audit and education results

Provide monthly HCC education for the Audit and Education teams based on audit findings and risk

Communicate and problem-solve with senior department managers about specific HCC documentation and coding issues, and training needs

Bachelor's degree and/or relevant work experience preferred

5+ years of experience in program management

Owns the end-to-end management of cross-functional implementations/projects, including project plan creation, stakeholder engagement/management, and on-time completion

5+ years of experience in Managed Care Health Insurance and/or Managed Care Consulting

4+ years of leadership experience

4+ years of Risk Adjustment strategic experience

2+ years experience using data and metrics to drive improvements in programs

Support your manager by guiding decisions and implementation on an ongoing basis

3+ years of experience in Business Strategy or Healthcare Analytics

2+ years of related work experience in healthcare

SQL (or related) data experience

Experience with ROI, sizing, and valuation analysis

2+ years of experience with implementing strategic initiatives

• Escalate appropriate coding audit issues to management as required

• Strong organizational skills; ability to time manage effectively

o 2 years’ experience in managed healthcare environment related to claims and/or coding audits

o Significant HCC experience (including knowledge of HCC mapping and hierarchy)

• Knowledgeable of coding/auditing claims for Medicare and Medicaid plans

• Extensive knowledge of ICD-9 & ICD-10 diagnostic coding and auditing

Work closely with performance management and reporting teams to provide data and reporting necessary for practice and provider scorecards.

Advanced data manipulation skills, with 3+ years of SQL experience

Advanced MS Excel skills, with 3+ years experience

Medicare and/or Risk Adjustment experience/knowledge preferred

Work closely with internal teams (Actuarial, Health Economics, and Finance) to provide data and insights necessary for financial forecasts and projections.

Perform other related responsibilities as assigned.

Required Experience/Knowledge, Skills & Abilities

3-5 years of Program and/or Project management experience.

5-7 years of Program and/or Project management experience.

Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Focuses on process improvement, organizational change management, program management and other processes relative to the business.

Leads and manages team in planning and executing business programs.

Bachelor’s Degree or equivalent combination of education and experience

Continues education to maintain high level of proficiency in Risk Adjustment field.

Maintains RN and CRC certifications.

Executes other responsibilities per business needs.

Must have minimum of 3 years of clinical experience as a Registered Nurse (RN)

Must have Certified Risk Adjustment Coder (CRC)Certification

4 to 6 years of account management or client project management experience

Strong time management skills, highly organized, self-motivated, and able to work under strict timelines with minimal day-to-day supervision

Proactively identify and manage opportunities to expand the scope of Episource solutions used by client organizations

Work collaboratively with internal departments and external vendors to coordinate project delivery and provide clients with a superior client services experience

Manage a high volume of client communication and manage the timely resolution of all outstanding client issues

Previous health care experience highly preferred, particularly in the Risk Adjustment space