REMOTE - Medical Risk Adjustment Vendor Manager - R9405

Location: Boise City

REMOTE
- Medical Risk Adjustment Vendor Manager - R9405

Join to apply for the REMOTE
- Medical Risk Adjustment Vendor Manager - R9405 role at Care Source

REMOTE
- Medical Risk Adjustment Vendor Manager - R9405

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- Medical Risk Adjustment Vendor Manager - R9405 role at Care Source

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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.

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 Care Source 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 Care Source 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

Salary

Compe…