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Senior Director Risk Adjustment Strategy & Program Management - Florida Blue Medicare
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- The Sr Director, Risk Adjustment Strategy and Program Management is responsible for leading risk adjustment strategy and related revenue management for Florida Blue Medicare.
- The Sr Director, Risk Adjustment Strategy and Program Management works collaboratively with Florida Blue Medicare, Florida Blue, and GuideWell executives and leadership to lead risk adjustment strategy and process.
- Directs and oversees risk adjustment strategy, including prospective and retrospective chart review and procurement processes; internal and external audits preparation and risk mitigation; data analysis to support risk revenue accruals; CMS encounter data submissions for FBM's Medicare Advantage membership to ensure complete and accurate risk capture.
- Provides strategic leadership to influence corporate strategy relative to FBM's risk adjustment strategies and continues to develop and evolve coding accuracy in concert with the Medicare Advantage industry and federal regulation.
- Accountable for developing prospective and retrospective risk adjustment review processes that are in compliance with all government regulations to drive accurate coding for Florida Blue Medicare in support of accurate risk capture; efforts will serve in partnership with FBM Stars and HEDIS quality programs
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