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TEKsystems Medicare Risk Program Manager in Des Moines, Iowa

Description:

Open to 100% remote candidates; prefer local candidates to the Midwest or Des Moines, IA.

As a Medicare Risk Program Manager, you will be responsible for the development and maintenance of robust Medicare Risk Adjustment programs to ensure the health plan fully understands the illness burden of our membership. In this critical individual contributor role, you will manage risk adjustment programs, support the strategy execution and analyze risk adjustment program performance data to identify, lead and prioritize strategies to improve risk scoring accuracy in alignment with Wellmark strategies. As a driver of Medicare Advantage (MA) company-identified initiatives, you will be the point-person for driving success on coding accuracy and risk adjustment programs. You won’t do it alone. In this role, you will partner alongside Wellmark, and joint venture, team members focused on program management, analytics, provider performance, and more to drive change and progress.

As this is a newly created role, the opportunity to build out risk adjustment related programs around identified strategies excites you! You are ready to use your MA experience in initiative development, data analytics, medical coding accuracy, risk adjustment, process management, and change management to make an impact. Collaboration is critical in this role, not just internally but externally with joint venture partners and MA specific vendors. You are organized, flexible, and results-oriented, leading you to take initiative and problem-solve to meet key objectives.

Daily Duties:

Develop and maintain a Risk Adjustment work-plan and convene committees and workgroups as needed.

Responsible for implementation and oversight of risk adjustment related initiatives and projects.

Partner with internal teams and associated external vendor partners to monitor program and vendor performance, facilitate oversight and performance improvement activities as needed.

Collaborate with internal and external teams to ensure complete and accurate reporting of risk adjustment data in accordance with Centers for Medicare and Medicaid Services (CMS) requirements.

Analyze risk program performance data to identify and prioritize strategies to help achieve risk adjustment program objectives.

Coordinate and develop indicators related to risk adjustment operations to inform leadership on progress of activities and risk adjustment programs.

Partner with internal stakeholders and/or external vendors in the definition, design, implementation, and maintenance of data files and data extracts to meet reporting needs of coding accuracy initiatives.

Apply and maintain knowledge of applicable current and proposed laws, regulations, and CMS guidance applicable to risk adjustment specifically, and general knowledge of Medicare Advantage and ACA/Exchange based requirements.

Collaborate with Medicare Advantage Network Performance team in support of delivering provider education to facilitate clinical documentation improvement and improve provider performance and outcomes.

Skills:

Medicare, CRC, ICD-10-CM, CPT

Top Skills Details:

Medicare,CRC,ICD-10-CM,CPT

Additional Skills & Qualifications:

Bachelor's degree or direct and applicable work experience.

4+ years of related healthcare industry experience.

2+ years of experience in managing Medicare Advantage Risk Adjustment programs.

Knowledge of CMS rules and requirements of Medicare Advantage Health Plans.

Excellent analytical skills, data management capabilities, and strong attention to detail. Ability to review data and provide measurable outcomes and trend measures to support and influence business decisions.

Technical aptitude to learn new data management and analysis tools or methodologies quickly.

Strong analytical, problem solving, and critical and strategic thinking skills. Willingness to take an innovative, creative approach to solving problems and developing solutions.

Strong written and verbal communications skills with the ability to share technical insights and recommendations with varying stakeholder audiences, including healthcare providers and external vendors. Adapts communication based on audience.

Proficiency with the Microsoft Office Suite.

PREFER:

Knowledge of industry standard ICD-10-CM and CPT coding principles.

Certified Risk Adjustment Coder (CRC)

Experience Level:

Intermediate Level

About TEKsystems:

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

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