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Director of Risk Adjustment
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- Oversee contracted vendor activities and overall performance in the areas of risk adjustment, coding improvement, chart review, and reconciliation.
- Develop and direct implementation of Risk Adjustment Strategic Plan in cooperation with key business partners including provider medical groups, coding, information systems, risk adjustment team, and finance department.
- Develop and oversee implementation annual initiatives for risk adjustment and revenue management initiatives to support the overall strategic goals.
- Ensure risk adjustment and revenue enhancement activities are in strong alignment with PacificSource values, positive provider engagement, and improving care to our members.
- Interface with Pharmacy Benefits Manager vendor to ensure accurate Medicare Part D reconciliation procedures.
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