Please contact your Administrator to change your authorization settings.
- Manages the daily workflow of Risk Adjustment strategies, which includes submissions, technical processes, reconciliations, provider engagement, provider coding outreach, In-Home Health Assessment (IHA), chart retrieval, and coding.
- Follows the strategic direction and implements risk adjustment initiatives required to achieve the business goals and objectives.
- Responsible for optimizing our vendor partner relationships for all risk adjustment areas such as, IHA, encounter submissions, risk mitigation, and chart retrieval and coding.
- Responsible for the development of actionable training materials, onboarding materials, reporting metrics, including scorecards for both internal and external stakeholders.
- Communicate Risk Adjustment program to internal & external audiences so they understand program objectives, goals, benefits, risks, regulations, requirements for risk adjustment.
- Partner with business owners from various teams within the organization to communicate timelines, risk adjustment methodology, program expectations and results of risk adjustment initiatives.
- Responsible to identify risk areas within existing Risk Adjustment programs and execute contingency plans with all involved key stakeholders.
- Responsible for documenting workflow process, standard operating policies and procedures and establishing robust monitoring programs that ensures performance metrics are achieved in compliance with CMS regulations, mitigating our risk adjustment data validation exposure/risk.
- Interact with leading industry experts routinely to design and develop core educational materials for the prospective risk adjustment program.
- Services will include but are not limited to:
- Develop prospective operations and track trending with month over month and year over year trending to continuously improve.
- Execute programs and work closely with the Analytics team to drive actionable and insightful reporting while seeking feedback from participating providers.
- Implement recommended suggestions for program improvement and communicate these changes both internally and externally.
- Ability to forecast and budget appropriately for provider incentives related to the prospective programs.
- Required Bachelor's Degree or equivalent, in field of study requiring consistent demonstration of communication, interpersonal, leadership and analytical skills, such as finance, accounting or business management or related field.
- Preferred Master's Degree or equivalent
- BSN/RN preferred or equivalent clinical experience
- Five (5) to eight (8) years' experience managing and leading teams, preferably in a provider office setting
- Three (3) to five (5) years' experience in the healthcare setting, preferably in Risk Adjustment or Medicare/ACA Operations with design and program implementation experience.
- 7 years of relevant experience in health care related field including experience in a leadership role Required
- 3 years of relevant experience in project management Required
- 1 year of relevant experience in leading and developing teams Preferred
- Coding Certification preferred through AAPC or AHIMA, preferably either one of the below within one year of hire;
- Certified Professional Coder (CPC)
- Certified Coding Specialist (CCS)
- Pallet to Waist (6" from floor) > 5 lbs: Seldom up to 10 lbs
- Waist to Waist > 5 lbs: Seldom up to 10 lbs
- Waist to Chest (below shoulder) > 5 lbs: Seldom up to 10 lbs
- Waist to Overhead > 5 lbs: Seldom up to 10 lbs
- Bilateral Carry > 5 lbs: Seldom up to 10 lbs
- Unilateral Carry > 5 lbs: Seldom up to 10 lbs
- Pushing Force > 5 lbs: Seldom up to 10 lbs
- Pulling Force > 5 lbs: Seldom up to 10 lbs
- Sitting: Frequently
- Standing: Occasionally
- Walking: Occasionally
- Forward Bend - Standing: Seldom
- Forward Bend - Sitting: Occasionally
- Trunk Rotation - Standing: Seldom
- Trunk Rotation - Sitting: Occasionally
- Reach - Above Shoulder: Seldom
- Reach - at Shoulder or Below: Seldom
- Handling: Occasionally
- Forceful Grip > 5 lbs: Seldom
- Forceful Pinch > 2 lbs: Seldom
- Finger/Hand Dexterity: Frequently
Primary Location
SITE - Priority Health - 1241 E Beltline - Grand RapidsDepartment Name
Risk AdjustmentEmployment Type
Full timeShift
Day (United States of America)Weekly Scheduled Hours
40Hours of Work
40Days Worked
Monday - FridayWeekend Frequency
N/ACURRENT COREWELL HEALTH TEAM MEMBERS - Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.
Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.
Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.
An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.
You may request assistance in completing the application process by calling 616.486.7447.
Beaumont Health is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, gender identity, sexual orientation, age, status as a protected veteran, or status as a qualified individual with a disability.