REMOTE - Sr. Manager, Medical Risk Adjustment Analytics - R12618

Job SummaryThe Senior Manager, Medical Risk Adjustment Analytics is responsible for the day to day operations of the risk adjustment function across all lines of business for the organization related to identification of member level risk opportunity, assignment of member level intervention approaches, risk adjustment data analytics and tracking ROI performance at an intervention level.Essential FunctionsAnalyzes member information to ensure the Risk Adjustment Factor accurately reflects the membership health profileDevelops and implements processes and procedures to ensure the accuracy and completeness of the Medicare Risk Adjustment, Medicaid and ACA/Marketplace data, and to ensure compliance with all CMS and State regulations and guidelinesDevelops and maintains documentation of the Medicare Risk, ACA/Marketplace and Medicaid Adjustment processesAnalyzes and monitors clinical Risk Adjustment reports to and from CMS to assure data accuracy and complianceSupports the development of monthly revenue accruals and forecast related to the risk adjustment activitiesMaintain excellent understanding of all CMS and state requirements and directives for Risk Adjustment to ensure process is compliant with these requirementsOversees and monitors data submission for attestation to CMS for Risk AdjustmentOversees vendor and internal processes for accurate and timely Risk Adjustment Factor calculations across Medicare, ACA/Marketplace and Medicaid lines of businessRecruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions including employment, termination, performance reviews, salary reviews, and disciplinary actionsPerform any other job duties as requestedEducation And ExperienceBachelor of Science degree in Finance, Business Administration, or Clinical related field or equivalent work experience is requiredSeven (7) years of experience in analyzing health care claims data and/or risk scores, to include database experience (SAS, SQL, or Access), requiredThree (3) years of management/supervisory experience requiredExperience in communicating and presenting to senior leadership preferredKnowledge of health care reporting standards preferredManaged care or healthcare experience is preferredCompetencies, Knowledge And SkillsExpert proficiency level with Microsoft ExcelKnowledgeable of Medicare/CMS Risk Adjustment regulationsKnowledgeable of ICD-10 and CPT codesAbility to manage, develop, motivate and reward professional staffAbility to effectively report data, analyze facts, and exercise sound business judgment when making recommendationsCritical listening and thinking skillsAdvanced proficiency with Microsoft Suite to include, Word, Power Point and OutlookAbility to work independently and to manage multiple priorities with limited resourcesAbility to analyze problems, draw conclusions, develop processes and communicate status and resultsExcellent oral and written communication skillsAbility to interact with executive levels of management as well as external stakeholdersLicensure And CertificationNoneWorking ConditionsGeneral office environment; may be required to sit or stand for extended periods of timeCompensation Range$113,000.00 - $197,700.00 CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.Compensation TypeSalaryCompetencies Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the BusinessThis job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.