Medical Risk Adjustment Vendor Manager

CareSource; United States; Remote; USD 61,000 - 99,000; Full time

Job summary

CareSource seeks a Medical Risk Adjustment Vendor Manager to support quality program execution through data analysis and vendor management. The role demands effective collaboration with internal teams and thorough understanding of Risk Adjustment processes in healthcare management.

Qualifications

• Minimum of three years in a Managed Care Organization.
• Project planning and management experience preferred.
• Knowledge of Medicare Advantage and Risk Adjustment principles.

Responsibilities

• Manage vendor relationships and projects.
• Prepare analyses and ensure compliance with CMS regulations.
• Identify trends in Risk Adjustment data and implement improvement initiatives.

Skills

Interpersonal skills

Analytical skills

Critical thinking

Project management

Education

Bachelor’s Degree in Business or Healthcare Administration

Tools

Microsoft Office Suite

SAS

SQL

PowerBI

Job description

Job Summary:

The Medical Risk Adjustment Vendor Manager provides data-driven strategy and risk adjustment subject matter expertise to internal and external stakeholders for Quality Risk Adjustment program execution.

Essential Functions:

• Support ongoing management of In-Home Assessment (IHA) vendor relationships and projects
• Lead vendor pend resolution activities with support from internal stakeholders
• Prepare integrated analysis and reports to ensure the accuracy and completeness of Risk Adjustment (RA) data and ensure compliance with all CMS regulations and guidelines
• Identifies trends and patterns within the RA data and medical record coding to segment and identify areas of risk and opportunity
• Identify and implement performance improvement initiatives convening multidisciplinary teams to improve RA program execution
• Ensures that milestones, timelines and KPI’s are met and creates work plans based on vendor input and vendor recommendations
• Coordinates data handoffs between internal Risk Adjustment team and Vendors
• Aid in identifying additional diagnostic tests and interventions needed to close open conditions
• Coordinates collaboration with internal CareSource teams and external vendors for Risk Adjustment interventions and education
• Perform any other job-related instructions, as requested

Education and Experience:

• Bachelor’s Degree in Business, Healthcare Administration, a related field, or equivalent years of relevant work experience is required
• Minimum of three (3) years of experience in a Managed Care Organization or other healthcare related field is required
• Project planning and project management experience is preferred

Competencies, Knowledge and Skills:

• Expert level proficiency in Microsoft Office Suite to include Word, Excel, PowerPoint, Outlook, Visio, MS Project, and Adobe Professional
• Skilled working in databases (SAS, SQL, or Access)
• Ability to manipulate and interpret reports and data in a variety of formats including but not limited to: PowerBI, Excel and SSRS
• Ability to develop and implement project plans, influence responsible parties to complete tasks on time, prioritize and accomplish goals
• Strong interpersonal skills and high level of professionalism
• Effective listening and critical thinking skills
• Ability to work independently and within a team
• Ability to create and maintain excellent working relationships
• Knowledge of Medicare Advantage, Health Exchange and Risk Adjustment principles
• Effective written and verbal communication skills
• Ability to work independently and within a team environment
• Knowledgeable of ICD-9/ICD-10 and CPT codes
• Demonstrates analytical/problem solving skills to perform a variety of complicated tasks
• Possesses critical thinking/listening skills

Licensure and Certification:

• PMP or Six Sigma Green Belt preferred

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time
• May be required to travel less than 10% of the time

Compensation Range:

$61,500.00 - $98,400.00

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Salary

Organization Level Competencies

• Create an Inclusive Environment

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds. #LI-SD1