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.
• 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 processes
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 populations
• 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.
Apply on company website