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Director, Risk Adjustment Programs
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- The Director of Risk Adjustment Programs is the subject matter expert (SME) that provides guidance for vendor-related issues and overall program management for the risk adjustment programs including, but not limited to, retrospective and prospective initiatives.
- Manages the activities of outside vendor partners by directing risk adjustment outsourcing strategies & governance.
- Works with WellCare’s provider network (IPAs and independent providers), regional provider relations’ networks, and other key personnel to help resolve medical record acquisition issues (i.e. barriers to access to the health records).
- Develops and implements Corrective Action Plans (CAPs) when necessary in order to obtain successful risk adjustment program completion and expected ROIs.
- Examples include internal and external staffing requirements needed to successfully complete CMS’ Jan. 31st sweep date, Risk Adjustment Data Validation (RADV) deadlines, vendor home visits programs, special pilot studies, inter-departmental medical record audits (MRA/AMRR), etc
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