Job Information
Lumeris Risk Adjustment Solutions Manager in United States
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Position:
Risk Adjustment Solutions Manager
Position Summary:
Acts as a subject matter expert and is responsible for developing and facilitating the implementation of new and existing healthcare Quality & Risk Adjustment strategies. Advises other departments and clients on quality & risk adjustment initiatives and provides educational programs; conducts data collection; and reporting and monitoring for key performance measurement activities.
Job Description:
Primary Responsibilities
Guides a comprehensive Quality and/or Risk Adjustment strategy for our clients by developing data mining strategies, facilitating collection methodology and an effective risk adjustment program, standardizing workflows, ensuring successful completion of internal/external data validations (for RADV Audit), and developing and facilitating implementation of training program for internal and external clients.
Develops and maintains effective internal and external relationships through effective and timely communication.
Synthesizes and organizes data, presents information, and provides executive summary of material.
Maintains accountability for outstanding customer service to all external and internal customers.
Takes initiative and action to respond, resolve, and follow up with all customers in a timely manner.
Develops and maintains an expert level of knowledge of Medicare and risk-based reimbursement methodologies.
Maintains professional and technical knowledge by attending educational workshops, reviewing professional publications, establishing personal networks, and participating in professional societies.
Manages and improves various department processes.
Facilitates the development of key performance indicators.
Presents performance results and findings regularly including the overall RAF score, improvement strategies, and tactics.
Serves as a subject matter expert for internal and external clients.
Supports activities of internal RADV monitoring programs and internal and external RADV audits.
Performs other duties as assigned.
Qualifications
Bachelor's degree in Health Administration, Business Administration or related field or equivalent
5+ years of experience within Healthcare, Health plan, or Health System required, including payer, hospital, Medicaid/Medicare, provider environment or managed care or the knowledge, skills, and abilities to succeed in the role
Knowledge of Risk Adjustment Payment methodologies and understanding of the CMS HCC, HHS, and Medicaid
Strong project management skills with the proven ability to guide multiple job functions under pressure with shifting priorities
Detail oriented with the ability to identify risk
Proficiency in Microsoft Office Programs including Word, PowerPoint, Excel, and Outlook
Excellent organizational capabilities with ability to work effectively as a team player
Strong aptitude for critical thinking and demonstrated data skills
Excellent interpersonal and communication skills
Ability to collaborate at all levels internally and externally
Strong data and quantitative problem-solving skills
Ability to travel up to 30%
Travel to Chicago once a month.
Working Conditions
- While performing the duties of this job, the employee works in normal office working conditions.
Disclaimer
- The job description describes the general nature and level of work being performed by people assigned to this job and is not intended to be an exhaustive list of all responsibilities, duties and skills required. The physical activities, demands and working conditions represent those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job duties and responsibilities.
Lumeris is an EEO/AA employer M/F/V/D.
The hiring range for this position is:
$84,600.00-$113,775.00
Factors that may be used to determine your actual pay rate include your specific skills, experience, qualifications, location, and comparison to other employees already in this role. This role may also be eligible for incentive compensation. At Lumeris, we are committed to providing a total rewards package that supports your overall well-being. Our benefits include medical, vision, dental, well-being programs, 401(k) with company matching, life insurance, paid time off including paid leave, and so much more. Learn more by visiting our Careers Page (https://www.lumeris.com/healthcare-consulting-careers/) .
Member Facing Position:
Yes- Member Facing Position
Location:
United States
Time Type:
Full time
Lumeris and its partners are committed to protecting our high-risk members & prospects when conducting business in-person. All personnel who interact with at-risk members or prospects are required to have completed, at a minimum, the initial series of an approved COVID-19 vaccine. If this role has been identified as member-facing, proof of vaccination will be required as a condition of employment.
Join Our Growing Team!
Lumeris is bringing common sense back to the business of healthcare by empowering value-based care. We create the partnerships and perspectives that are making healthcare safer, more affordable and more personalized for providers, patients and payers alike.
We were founded on the belief that it should be easier to provide the right care, at the right time, at the right cost. Our model is bringing that belief to life, improving outcomes and empowering financial sustainability along the way.
Why Join Lumeris?
At Lumeris, you will be part of team that is focused on solving the nation’s healthcare problem, and you will be able to contribute to our purpose. Our environment is fast-paced, change-oriented and focused on growth and employee engagement. At Lumeris, we know that talent is best utilized when given the opportunity to succeed. That is why we have removed the boundaries that inhibit success and focus on fostering an environment that allows employees to utilize their talents.