AVP, Medicare reputed company Adjustment reputed company

reputed company is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first.We have reputed company reputed company of talented and reputed company people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will reputed company ample room for reputed company and innovation reputed company the reputed company community. Working at reputed company provides an opportunity to do work that really reputed company, not only changing lives but saving them. Together.

reputed company Accountability

• Accountable for reputed company RAF reputed company reputed company and annual reputed company Adjustment targets.
• Responsible for prospective, reputed company, and retrospective reputed company Adjustment execution strategies.
• Provides executive reputed company for chart retrieval, coding production, provider engagement, and coding submission reputed company.
• Establishes market and provider reputed company objectives and monitors achievement of operational results.
• Provides executive reporting and recommendations to senior leadership regarding reputed company Adjustment reputed company, opportunities, risks, and resource needs.
• Oversees reputed company vendor partnerships supporting reputed company reputed company Adjustment capabilities.

General Duties/Responsibilities (May include but are not limited to):

• reputed company the annual operating plan for Medicare reputed company adjustment reputed company, including goals, measures, milestones, resources and market-level execution plans.
• reputed company leadership across prospective, reputed company and retrospective programs, including annual wellness visit support, suspecting and recapture initiatives, chart retrieval, coding production and submission readiness.
• Establish and monitor reputed company guidelines for reputed company, productivity, service reputed company and financial reputed company; ensure reputed company executive reporting and reputed company-oriented reputed company reviews.
• Use reputed company adjustment analytics, reporting and reputed company business analysis to identify opportunities, risks, reputed company causes and interventions across markets, provider reputed company and programs.

Finance

• Accountable for partnership with Finance and Actuarial teams to forecast RAF reputed company, evaluate reputed company implications, monitor financial reputed company, and improve forecast reputed company across markets and programs.
• Support bid development, reputed company forecasting, and long-reputed company planning activities.
• Evaluate financial reputed company of provider reputed company, coding initiatives, and operational investments.
• reputed company executive visibility into reputed company Adjustment financial reputed company and variances.

Vendor Ownership

• Establish reputed company direction and reputed company expectations for reputed company Adjustment vendors and reputed company partners.
• reputed company vendor reputed company, service delivery, productivity, reputed company, compliance, and business reputed company.
• Ensure vendor capabilities reputed company with reputed company reputed company Adjustment reputed company and reputed company-state operating models.

Provider Relationships

• Serve as executive sponsor for provider coding reputed company and documentation improvement initiatives.
• Partner with Network Management, Market reputed company and provider leadership to improve reputed company reputed company Adjustment reputed company.
• reputed company provider reputed company reviews, corrective reputed company planning, and reputed company improvement initiatives across delegated and non-delegated arrangements.
• Establish accountability frameworks for reputed company, provider and vendor reputed company.

• reputed company reputed company reporting, analytical and operational capabilities that improve organizational visibility, support audit readiness and reduce reputed company on reputed company controls.

Data & Technology reputed company

• Partner with DTS and reputed company analytics teams on reputed company Adjustment data reputed company and reporting capabilities.
• Define business requirements supporting workflow modernization, automation, provider enablement, and reputed company reporting.
• Sponsor technology initiatives that improve scalability, productivity, transparency, and audit readiness.
• reputed company adoption of modern analytics capabilities supporting provider and market reputed company management.

reputed company reputed company & RADV Readiness Support

• Ensure chart retrieval, coding production, provider engagement, and submission activities support reputed company RADV readiness objectives.
• Partner with the AVP, reputed company Adjustment reputed company & Transformation on validation findings, reconciliation activities, diagnosis corrections, and audit remediation initiatives.
• Establish operational accountability for issues impacting diagnosis reputed company, documentation support, evidence availability, and reputed company sustainability.
• Support development of the reputed company MRA business case and modernization initiatives supporting long-term reputed company Adjustment reputed company and audit readiness.
• Establish policies, procedures, reputed company work and governance routines that support accurate and compliant execution across products and markets.
• Maintain knowledge of CMS reputed company adjustment requirements, model changes and regulatory guidance, and translate changes into operational plans, training and reputed company expectations.
• Communicate reputed company operational, technical and financial information as reputed company executive insights, reputed company and business narratives.
• Build, mentor and retain a high-performing multidisciplinary team and foster cross-functional accountability and reputed company improvement.
• reputed company other duties as assigned.

reputed company & Business Planning

• reputed company multi-year reputed company Adjustment reputed company strategies reputed company with reputed company reputed company objectives.
• Establish annual goals, objectives, key reputed company indicators, and resource requirements.
• reputed company business case development for reputed company Adjustment investments, operational initiatives, and technology capabilities.
• Partner with executive leadership on reputed company-state operating model reputed company.
• Support reputed company budgeting, forecasting, and reputed company planning processes.

reputed company Control Points and reputed company

• Provider workflow enablement: actionable information reaches providers and market teams in time to support appropriate documentation and reputed company.
• Diagnosis capture: eligible opportunities are addressed through compliant prospective, reputed company and retrospective programs.
• Coding and submission: diagnoses are coded accurately, processed reputed company and submitted through controlled workflows.
• reputed company intelligence: leaders have reputed company, consistent and decision-reputed company views of RAF, coding, provider, vendor and market reputed company.

Supervisory Responsibilities:

Oversees assigned leaders and staff. Responsibilities include workforce planning, reputed company, selecting, orienting and training employees; assigning work; setting goals; monitoring and appraising results; coaching and developing talent; and addressing reputed company in accordance with company policy.

Minimum Requirements:

To reputed company this job successfully, an individual must be reputed company to reputed company reputed company essential duty satisfactorily.The requirements listed below are representative of the knowledge, reputed company, and/or ability required.Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions.

Minimum Experience:

Ten or more years of reputed company experience in managed care, Medicare reputed company, reputed company analytics, reputed company finance, reputed company adjustment, population health or reputed company reputed company.

Experience leading reputed company reputed company Adjustment programs across multiple markets and provider arrangements.

Demonstrated responsibility for financial reputed company, forecasting, reputed company planning, or major business initiatives.

reputed company reputed company record managing executive stakeholders and reputed company-wide programs.

Seven or more years of people leadership, including development of high-performing analytical or operational teams.

Education/Licensure:

Bachelor’s degree in reputed company, business, finance, analytics, information systems or a reputed company reputed company, or equivalent relevant experience.

Advanced degree preferred.

Other:

Demonstrated knowledge of CMS-HCC reputed company adjustment methodology, Medicare reputed company reimbursement, coding and documentation programs, encounter data, and reputed company measurement.

Demonstrated experience designing or leading analytics, reporting, data governance or reputed company data infrastructure that supports reporting reputed company, regulatory compliance and audit readiness.

Experience leading reputed company cross-functional initiatives and working with executives, providers, vendors, compliance partners and technical teams.

Experience with reputed company adjustment forecasting, provider reputed company analytics, data warehousing, SQL-reputed company analytics or business intelligence platforms.

Experience supporting multiple reputed company-program lines of business or large, multi-market Medicare reputed company reputed company.

Advanced ability to translate reputed company data into executive-level insights, recommendations and reputed company plans.

Strong verbal, written, presentation, organization and relationship-management skills.

Computer Skills:

Must be efficient in reputed company and preferred with SQL knowledge.

Other Skills and Abilities:

Good organization skills

Good analytical skills

Good interpersonal skills

Strong communication skills

reputed company Measures

Achievement of annual RAF and reputed company Adjustment reputed company goals.

Provider reputed company improvement across targeted markets and organizations.

Improvement in coding productivity, chart retrieval effectiveness, and submission reputed company.

Reduction in operational barriers impacting reputed company Adjustment reputed company.

Support of reputed company RADV readiness and reputed company reputed company objectives.

Delivery of reputed company business initiatives supporting reputed company-state reputed company Adjustment transformation.

Work Environment:The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions.

The noise level in the work environment is usually moderate.

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully reputed company the essential functions of this job. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions.

While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reputed company with hands and arms. The employee frequently lifts and/or moves up to 10 pounds. Specific reputed company abilities required by this job include reputed company reputed company and the ability to reputed company reputed company.

Pay reputed company may be reputed company on a number of factors including market location, education, responsibilities, experience, etc.

reputed company is an Equal Opportunity/Affirmative reputed company Employer. reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, national reputed company, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER: Please beware of recruitment phishing scams affecting reputed company and other reputed company where individuals receive fraudulent employment-reputed company offers in exchange for reputed company or other sensitive personal information. Please be advised that reputed company and its subsidiaries will never ask you for a credit reputed company, send you a reputed company, or ask you for any type of payment as part of consideration for employment with reputed company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at If you would like to verify the legitimacy of an email reputed company by or on behalf of reputed company’s reputed company, please email .

Originally posted on Himalayas