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Astrana Health · 2 weeks ago

Risk Adjustment Manager

California, CA

Full-time

Hybrid

Mid, Senior Level

$102K/yr - $115K/yr

5+ years exp

Astrana Health is a company focused on quality and risk adjustment initiatives. The Risk Adjustment Manager will oversee various programs and operations to ensure accurate documentation and compliance in patient care, while collaborating with internal and external stakeholders.

Health CareMedical

Growth Opportunities

Responsibilities

Oversees daily regional operations of the coding and specialists’ team, retrospective and prospective review teams and programs and ensures the appropriate strategy, tactics and data capture processes are in place

Collaborate closely with providers and regional network leadership teams to implement risk adjustment education, processes, and programs effectively for accurate and compliant capture of members' conditions

Identify and analyze implications of key changes to the regulatory & policy environment on provider organizations in the areas of risk adjustment and compliance

Serves as the vendor(Chart review/AWV /Cozeva etc) and provider liaison to ensure coordination of efforts, effective relationship management, cost effectiveness, delivery of work product, quality of work, delivery of required training for internal associates and timely communication on all issues

Manage the regional employed NP program and the vendor driven AWV program

Audits the chart review outcomes provided by the risk adjustment vendor and audits provider coding trends to identify potential gaps

Support effective business relationships with external entities, including payers and health plan partners with continuous focus on performance improvement related to population clinical quality and patient experience goals

Requires significant collaboration with internal stakeholders including, but not limited to, primary care section and specialty service lines, IT, business services and finance, contracting, compliance, as well as external entities and vendors will be required

Manage regional Provider Incentive and Member Incentive Programs

Recover dx codes from institutional encounters through hospitalists/encounters

Roll out new regional programs as applicable to improve documentation and accurate coding

Ensure the accuracy of risk data in and out of core systems

Establish EMR connectivity with Astrana Health and provider group/IPA

Ensure compliance with all applicable regulatory and accreditation guidelines such as CMS, NCQA, DMHC etc

Develop policy and procedures as required for departmental improvements

Complete special projects when required

Qualification

Risk adjustment experienceHealthcare industry knowledgeAAPCAHIMA certificationProject managementManagerial experienceValue-based revenue experienceHealth plan guidelines knowledgeMicrosoft Office proficiencyCommunication skillsTime managementOrganizational skills

Required

Bachelor's Degree

Current AAPC or AHIMA certification (CCS, CCS-P, CPC, CPC-H, CPC-P, RHIT, or RHIA)

5 years' experience of risk adjustment, project management, operations, quality improvement or data analysis/reporting experience in the healthcare industry

5 years' experience in managerial or supervisory capacity

Previous experience in value-based revenue and risk adjustment improvement initiatives

Experienced with health plan guidelines/criteria/ICE/CMS/NCQA/DMHC

Ability to effectively present information within and outside the organization

Advanced ability to manage and work with minimal supervision or absence of detailed instruction

Strong computer skills with proficiency using all Microsoft Office products, and demonstrated ability and willingness to learn new software

Excellent time management, project management, organizational and communication skills