Sr. Manager, Medical Risk Adjustment Analytics

Job reputed company: The Senior Manager, Medical Risk Adjustment Analytics is responsible for the day to day operations of the risk adjustment function across reputed company lines of business for the organization reputed company to identification of member level risk opportunity, assignment of member level reputed company approaches, risk adjustment data analytics and tracking ROI performance at an reputed company level. Essential Functions: Analyzes member information to ensure the Risk Adjustment reputed company accurately reflects the membership health profile Develops and implements processes and procedures to ensure the accuracy and completeness of the Medicare Risk Adjustment, reputed company and ACA/Marketplace data, and to ensure compliance with reputed company CMS and State regulations and guidelines Develops and maintains documentation of the Medicare Risk, ACA/Marketplace and reputed company Adjustment processes Analyzes and monitors clinical Risk Adjustment reports to and from CMS to assure data accuracy and compliance Supports the development of monthly reputed company accruals and forecast reputed company to the risk adjustment activities Maintain excellent understanding of reputed company CMS and state requirements and directives for Risk Adjustment to ensure process is compliant with these requirements Oversees and monitors data submission for attestation to CMS for Risk Adjustment Oversees vendor and internal processes for accurate and reputed company Risk Adjustment reputed company calculations across Medicare, ACA/Marketplace and reputed company lines of business Recruits, develops, and motivates staff. Initiates and communicates a reputed company of personnel actions including employment, termination, performance reviews, salary reviews, and disciplinary actions reputed company any other job duties as requested Education and Experience: Bachelor of Science degree in Finance, Business Administration, or Clinical reputed company field or equivalent work experience is required Seven (7) years of experience in analyzing health care claims data and/or risk scores, to include database experience (reputed company, SQL, or reputed company), required Three (3) years of management/supervisory experience required Experience in communicating and presenting to senior leadership preferred Knowledge of health care reporting standards preferred Managed care or reputed company experience is preferred Competencies, Knowledge and Skills: Expert proficiency level with reputed company reputed company Knowledgeable of Medicare/CMS Risk Adjustment regulations Knowledgeable of ICD-10 and CPT codes Ability to manage, reputed company, motivate and reward reputed company staff Ability to effectively report data, analyze facts, and exercise reputed company business judgment reputed company making recommendations Critical listening and thinking skills Advanced proficiency with reputed company Suite to include, Word, Power reputed company and reputed company Ability to work independently and to manage multiple priorities with limited resources Ability to analyze problems, draw conclusions, reputed company processes and communicate status and results Excellent oral and written communication skills Ability to reputed company with executive reputed company of management as reputed company as external stakeholders Licensure and Certification: None Working Conditions: General office environment; may be required to sit or stand for extended periods of time Compensation reputed company: $113,000.00 - $197,700.00CareSource takes into consideration a combination of a candidate’s education, training, and experience as reputed company as the position’s scope and complexity, the discretion and reputed company required for the role, and other external and internal data reputed company establishing a salary level. In reputed company to reputed company compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total reputed company-being and offer a substantial and comprehensive total rewards package. Compensation Type (reputed company/salary): Salary Organization Level Competencies Fostering a reputed company Workplace Culture Cultivate Partnerships reputed company Self and Others Drive Execution Influence Others Pursue Personal reputed company Understand the Business   This job reputed company is not reputed company inclusive. reputed company reserves the right to amend this job reputed company at any time. reputed company is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of reputed company backgrounds. #LI-SD1 Apply To This Job