Description
SHIFT: Day Job
SCHEDULE: Full-time
Be part of an extraordinary team
We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
Build the Possibilities. Make an extraordinary impact.
The Risk Adjustment Strategic Manager is responsible for serving as a strategic partner for the Medicare business to Enterprise Risk Adjustment, Business Operations, Regulatory Compliance and Internal Audit business units. Identifies trends and strategizes how the business can be more efficient and effective in the market. Utilizes trend data to provide more strategic direction to providers.
How you will make an impact:
Assist management by overseeing day to day operations for risk adjustment programs including both prospective and retrospective, claims, vendor quality, and audits.
Develop metrics, policies, and procedures in support of required deliverables and validation of programs return on investment while ensuring the programs are in compliance with Center for Medicare and Medicaid Services (CMS) program requirements.
Serve as a strategic partner to the business and contributes to ideas and solutions.
Influence others and works effectively to establish and develop working relationships both internally and externally with business stakeholders.
Obtain and compile trend data and educates providers.
Collaborate with the operations risk and compliance teams in implementing and deploying Enterprise Risk and Compliance initiatives, processes, and tools.
Effectively drive remediation of risks and issues by collaborating with Business Operations, Internal Audit and Regulatory Compliance.
Find root cause and recommend innovative solutions.
Provide oversight and ensure complete and accurate coding for Medical Revenue Management programs driving the revenue we receive from CMS.
Serve as a subject matter expert on coding.
Lead and consult with operations on ad hoc requests/special projects.
Work collaboratively with Enterprise Risk Adjustment team, Business Operations, Regulatory Compliance, and Internal Audit.
Qualifications
Minimum Requirements:
Requires a BA/BS in a related field and minimum of 5 years of experience in a managed care setting with extensive risk adjustment experience with a focus on CMS audit experience; or any combination of education and experience, which would provide an equivalent background. Travel may be required.
Preferred Skills, Capabilities and Experiences:
Risk adjustment, Data analysis, Trend reporting, and Provider education experience preferred.
Risk adjustment vendor experience preferred.
Coding knowledge preferred.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide - and Anthem approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws. Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World's Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.
REQNUMBER: PS71397-Virginia
