Risk Adjustment Program Lead Job Columbus area,Indiana USA,Finance & Banking

Job Title:
Risk Adjustment Program Lead
Reports To:
Vice President, My Tru Advantage

The primary responsibility of the Risk Adjustment Program Lead is to serve as the subject matter expert for risk adjustment, maintaining oversight of all risk adjustment activities. This role will support Medicare Advantage and ACA risk adjustment programs.

Brief Description of Duties:

Serve as the expert on Medicare Risk Adjustment models; monitor regulatory changes, ensuring adherence to CMS/HHS guidelines
Develop and monitor metrics and KPIs to track the success of solutions and improvements; develop dashboards to share risk adjustment trends to key stakeholders; communicate risk adjustment impacts across all levels of the company
Conduct comprehensive research and analysis to identify trends and areas of opportunity related to risk adjustment; contribute to the development and implementation of strategic initiatives and a risk adjustment work plan; collaborate with plan partners to leverage a lean team and all possible resources to improve risk adjustment outcomes
Responsible for forecasting revenue and collaborating with finance team
Create and maintain department policies and procedures
Ensure plan readiness and compliance for RAD-V and CMS audits
Own vendor oversight of data integration and coding accuracy for Encounter Data Submissions and risk analytics

Minimum Skills Requirement:

Minimum of 5 years of experience in Medicare risk adjustment
Strong knowledge of CMS risk adjustment models/methodologies and HCC coding
Strong analytical, organizational, problem-solving, vendor management, and critical thinking skills
Ability to work independently and manage multiple projects involving cross-functional teams and external vendors
Ability to interpret and analyze complex data and translate this into meaningful, actionable information
High standards of quality and accuracy
Advanced skills in Microsoft Excel
Commitment to maintaining confidentiality in compliance with HIPAA

All positions are subject to change based on the needs of the business