The Risk Adjustment Revenue Manager is responsible for risk adjustment strategy and related revenue management for Security Health Plan’s Medicare, Affordable Care Act and Medicaid business. This individual provides development and implementation of programs and initiatives to improve the accuracy of the coding, including education; retrospective and prospective review processes; and vendor contract management; accountability for preparation for and management of the Centers for Medicare and Medicaid Services (CMS) and the Department of Health Services (DHS) auditing processes; management of encounter data processes; and management of applicable state and federal guidance. The Risk Adjustment Revenue Manager works collaboratively with Security Health Plan executives and leadership as well as Marshfield Clinic Health System (MCHS) executives and leadership to lead risk adjustment strategy and process.
JOB QUALIFICATIONS
EDUCATION
Minimum Required: Bachelor’s Degree in Business Administration, Finance, Health Care Administration, Management or related field required.
Preferred/Optional: Post graduate degree(s) desirable.
EXPERIENCE
Minimum Required: Five years of experience in risk adjustment or related area. Three years of experience in a management or leadership role and experience in the healthcare industry. Demonstrate a broad understanding of healthcare and health insurance. Demonstrate proficiency with verbal and written communication, strategic planning and business acumen.
Preferred/Optional: Working knowledge of CMS and/or Medicaid risk adjustment methodologies.
CERTIFICATIONS/LICENSES
The following licensure(s), certification(s), registration(s), etc., are required for this position. Licenses with restrictions are subject to review to determine if restrictions are substantially related to the position.
Minimum Required: Certifications in professional coding and risk adjustment coding from American Academy of Professional Coders. State of Wisconsin driver’s license with an acceptable driving record.
Preferred/Optional: None
Marshfield Clinic Health System is committed to enriching the lives of others through accessible, affordable and compassionate healthcare. Successful applicants will listen, serve and put the needs of patients and customers first.
Marshfield Clinic Health System is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.