Regional Manager, Risk Adjustment
Company: Molina Healthcare
Location: Columbus
Posted on: January 12, 2021
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Job Description:
Job Description Job Summary The Regional Manager of Risk
Adjustment is responsible for managing a team of professionals to
meet the needs of the Medicaid, Medicare, and Marketplace lines of
business as it relates to risk adjustment.
Knowledge/Skills/Abilities * Manages risk adjustment staff in
Regions (East, West, Central)* Monitors and tracks progress on risk
adjustment initiatives across the region* Coordinates with
Corporate Risk Adjustment to develop work plan and goal alignment
within the region* Ensures standardization across the region
related to risk adjustment for all lines of business (Medicaid,
Medicare, and Marketplace)* May establish state specific policies
and procedures outside of the enterprise risk adjustment model*
Analyzes regional reports and audit findings to track progress as
it relates to goals and KPIs* Implements coaching and training
plans* Escalate gaps in projects to Director or Senior Leadership*
Responsible for assisting the Director with implementation and
oversight of risk adjustment projects* Management of Medicaid
retrospective medical record review processesJob Qualifications
Required Education BS Degree in Finance, Healthcare Administration,
Business Administration or Health Information Management or
equivalent work experience Required License, Certification,
Association * 3 years' experience working in Risk Adjustment in a
healthcare environment* Proficiency with risk adjustment
methodologies* Understanding of healthcare terminology (CPT,
ICD-10)* Knowledge of coding, HCCs, risk adjustments concepts,
medical record review project management, encounter data
management, compliance audit concepts* Strong familiarity and
experience with underserved populationsPreferred Experience * 3 - 5
years management experience* Experience with risk adjustment data
validations or equivalent compliance audits* Prior experience with
CMS risk adjustment projects preferred.Preferred License,
Certification, Association CPHQ, RHIA, CPC, CRC or CCS To all
current Molina employees: If you are interested in applying for
this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation
package. Molina Healthcare is an Equal Opportunity Employer (EOE)
M/F/D/V.
Keywords: Molina Healthcare, Columbus , Regional Manager, Risk Adjustment, Executive , Columbus, Ohio
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