Senior Manager Risk Adjustment - Provider Initiatives (Remote - Florida Only)

What Is Your Impact?
The Senior Manager for Risk AdjustmentProvider Initiatives is responsible for providing leadership, coaching and regulatory compliance management for Medicare and Commercial Risk Adjustment activities required for risk-adjusted product offerings.

The Senior Manager will oversee Provider Initiatives for Risk Adjustment provider education programs including provider quality coding chart reviews, chart procurement/medical record documentation education for completeness and accuracy, provider engagement and RADV. Provider initiatives includes but not limited to overseeing staff performing the day-to-day provider outreach and education in compliance with CMS/HHS requirements for Risk Adjustment data submission and data validation (RADV) activities. These activities are critical to support data submission accuracy and, in turn, CMS/HHS revenue payment and payment adjustments.

Who Is Our Ideal Candidate?

They should currently reside in the state of FL and have their AAPC - Certified Professional Coder (CPC) and/or Certified Risk Coder (CRC) and/or AHIMA CCA Certified Coding Associate and/or CCS Certified Coding Specialist certifications. They should also have a Risk Adjustment background along with specific experience within the provider space.

The Key Responsibilities:

• Oversee the staff who is primarily focused on, but is not limited to, establishing, and nurturing collaborative relationships Provider Initiatives for Risk Adjustment programs including provider quality coding chart reviews, chart procurement/medical record documentation education for completeness and accuracy, provider engagement and RADV.

• Oversee staff and day to day operations and personnel for Risk Adjustment programs.

• Track, monitor and report all Risk AdjustmentProvider Initiatives to ensure accurate/timely deliverables and achieve deadlines.

• Coordination and collaboration with internal/external business partners to optimize resources for Risk Adjustment activities from various sources (sources such as EMR, onsite retrieval, CCDA, Availity, VSI, vendors, etc.)

• Monitor staff work assignments to maximize productivity in daily activities.

• Provide updates to Sr. Leadership on potential concerns with barriers, proactive management on staffing, capacity fluctuations and projects.

• Identify, manage, and report defects and exceptions in the workflow and seek solutions to reduce impacts to the Risk Adjustment activities.

• Mentor, coach, motivate, and develop staff responsible for oversight, monitoring, and development of key business processes that support Risk Adjustment activities, working in concert with multiple business partners including Provider Network, fellow Risk Adjustment teams, and Analytics.

• Ensure all staff trained correctly, timely and efficiently to include changes and/or enhancements to information and productivity tools for Risk Adjustment activities.

• Collaborate with key corporate stakeholders across organizational lines to optimize strategy and key business processes and to develop new business processes, infrastructure and capabilities that support Risk Adjustment objectives.

• Standardize business operations and maximize revenue and profitability in tandem with Sr. Leadership

• Establish and monitor internal controls necessary to ensure all activities impacted by CMS data submission compliance and processes meet internal compliance and CMS guidelines and to optimize operational effectiveness.

What Is Required:

• 5+ years related work experience. Experience Details: Risk Adjustment, Instructor or Educator, Medical Claims and Coding, Business Administration, Health Administration, Government Regulatory related or other relevant experience and/or education.

• 3+ years direct supervisory/management experience

• bachelor’s degree (Any related field including healthcare, business, finance, accounting) or additional related equivalent work experience

• In-depth knowledge of Medicare and/or Commercial Risk Adjustment Programs

• Excellent communication and collaboration skills both with internal and external audiences.

• Experience working with physician/facility practices and/or physician/facility medical coding and claims submissions

• Knowledge of operations, demand, performance, communications, resource capabilities and planning/scheduling

• Demonstrated problem solving ability and evidence of experience applying continuous improvement techniques.

• Demonstrated experience resolving escalated issues and barriers.

Required Certifications:

• AAPC - Certified Professional Coder (CPC) and/or Certified Risk Coder (CRC) and/or AHIMA CCA Certified Coding Associate and/or CCS Certified Coding Specialist

What Is Preferred:

• Master’s degree MBA/MHA or equivalent

• Knowledge of Risk Adjustment coding

• Demonstrated Florida Blue knowledge

• Demonstrated understanding of reform, and CMS/HHS compliance standards

• Demonstrated knowledge of Centers for Medicare and Medicaid Services (CMS), Reimbursement and Risk Adjustment Methodology

What We Offer:
As a Florida Blue employee, you will thrive in our Be Well, Work Well, GuideWell culture where being well as an individual, and working well as a team, are both important in serving our members and communities.
To support your wellbeing, comprehensive benefits are offered. As an employee, you will have access to:

• Medical, dental, vision, life, and global travel health insurance

• Income protection benefits: life insurance, Short- and long-term disability programs

• Leave programs to support personal circumstances

• Retirement Savings Plan includes employer contribution and employer match

• Paid time off, volunteer time off, 10 holidays and two flexible Well-Being days

• Additional voluntary benefits available and a comprehensive wellness program

Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for intern, part-time and seasonal employees may differ.
To support your financial wellbeing, we offer competitive pay as well as opportunities for incentive or commission compensation. We also conduct regular annual reviews with pay for performance considerations for base pay increases.
Annualized Salary Range:$88,100 - $143,100
Typical Annualized Hiring Range: $88,100 - $110,100

Final pay will be determined with consideration of market competitiveness, internal equity, and the job-related knowledge, skills, training, and experience you bring.
We are an Equal Opportunity/Protected Veteran/Disabled Employer committed to creating a diverse, inclusive, and equitable culture for our employees and communities.