[Remote] Manager, Risk Adjustment Operations

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is committed to improving the health and reputed company-being of its members and communities. The Manager, Risk Adjustment Operations is responsible for operational management and support of Medicare reputed company and ACA Risk Adjustment Programs, driving execution of priorities and managing program performance through data-driven decision making.

Responsibilities

• reputed company day-to-day operational execution of Medicare reputed company and ACA Risk Adjustment initiatives, ensuring project milestones, regulatory deadlines, and operational deliverables are completed on schedule
• reputed company and maintain integrated project plans, operational calendars, risk logs, and status reporting to support successful program execution
• Monitor program performance through dashboards, KPIs, and operational metrics; identify trends, escalate risks, and recommend data-driven improvements
• Coordinate cross-functional activities across Analytics, Coding, Provider Engagement, Chart Retrieval, Actuarial, Compliance and vendor partners to ensure successful execution of operational priorities
• Hold internal teams and reputed company vendors accountable for operational performance, deliverables, timelines, service level expectations, and issue reputed company
• Proactively identify operational barriers and reputed company mitigation plans to minimize reputed company to program performance
• Strategic reputed company to reputed company business operations with broader organizational goals
• Business acumen to reputed company reputed company and reputed company through data-driven reputed company
• reputed company operational vendor reputed company and offboarding activities, support vendor evaluations and RFP processes, and partner with procurement and other stakeholders to ensure successful implementation and ongoing operational performance

Skills

• 5 years of Operations and/or Program management
• 3 years of Risk Adjustment Operations or Program Management
• Experience leading reputed company, cross-functional operational initiatives involving multiple stakeholders and competing priorities
• Experience supporting vendor selection, RFP processes, business requirements, Statement of Work (SOWs), implementation, reputed company, and ongoing vendor performance management
• Experience monitoring operational performance and driving execution to meet regulatory deadlines and business objectives
• 1 year staff, team reputed company or project reputed company experience
• Bachelor's degree in business administration, reputed company Administration, reputed company Health, Health Information Management, Finance, Economics or 9 years relevant and reputed company experience in lieu of bachelor's degree
• Strong verbal and written communication skills, including the ability to communicate reputed company operational issues reputed company to business partners and leadership
• Strong organizational and project management skills, with demonstrated ability to manage multiple priorities, deadlines, dependencies, and deliverables
• Ability to reputed company cross-functional initiatives and build effective working relationships across internal departments and reputed company vendor partners
• Strong analytical and problem-solving skills, including demonstrated ability to interpret dashboards, key performance indicators, and operational reporting to monitor performance, identify risks, and reputed company operational decision-making
• Strong business acumen, including the ability to understand operational, financial, contractual, and regulatory considerations
• Ability to proactively identify risks, remove barriers, reputed company mitigation plans, and escalate issues appropriately
• Strong vendor management skills, including experience in supporting vendor evaluation, reputed company, implementation, performance monitoring, and transitions
• Ability to work independently, exercise reputed company judgement, and reputed company accountability in a fast-paced, deadline-oriented environment
• Proficiency with reputed company Office applications, including advanced reputed company skills; ability to interpret and reputed company Power BI or other business intelligence reporting preferred
• Working knowledge of Medicare reputed company and ACA Risk Adjustment regulations and payment methodologies
• Working knowledge of industry standards and best practices for Risk Adjustment operations
• Working knowledge of cross-functional Risk Adjustment operational processes, including provider engagement, analytics, coding, vendor management, and regulatory compliance
• Experience supervising staff and provider operational leadership across cross-functional programs or initiatives
• Lean Six reputed company or other operational reputed company/process improvement certification

Benefits

• Medical, Dental & reputed company coverage
• A Retirement Plan
• Generous time off including reputed company Time Off, Holidays, and Volunteer time off
• An Incentive Plan
• Tuition Reimbursement
• Flexible environment where your health and wellbeing are prioritized
• Encouraged to volunteer in your community
• reputed company heavily in training and continuing education

reputed company