Risk Adjustment, Program Manager
Posted on: November 22, 2020
Job Title: --Program Manager, Risk AdjustmentSupv
Approval/Date:Department:-- Risk AdjustmentHR Approval/Date:Job
Code:--FLSA Status:---- ExemptRange:--EEO Code:--Reports To:----
Director, Risk AdjustmentTier:-- JOB SUMMARY: Responsible for
supporting the programmatic functions of the Washington region's
risk adjustment program, including health assessment initiatives,
HCC risk adjustment data & documentation integrity, and supporting
vendor programs. Under the direction of the Senior Director of Risk
Adjustment, deploys and maintains regional programs to ensure a
Washington maintains a high performing risk adjustment
program.ESSENTIAL DUTIES & RESPONSIBILITIES: The duties listed
below are intended only as illustrations of the various types of
work that may be performed.-- The omission of specific statements
of duties does not exclude them from the position if the work is
similar, related or a logical assignment.
- Supports patient engagement and outreach programs to facilitate
comprehensive health assessment for Medicare Advantage patient
population, and other managed or risk-based populations. This
includes ensuring high risk patients are being seen and that all
patients are seen in a timely manner.
- Implements and manages vendors for programs such as in health
assessments and embedded NP visits.
- Supports implementation of programs designed to ensure all
diagnosed codes and conditions are properly supported by
appropriate documentation in patient chart.-- Programs include, but
are not limited to training and educational activities and
coordination of random targeted documentation audits and concurrent
follow up feedback.
- Supports coordination of clinician chart audit activities and
operational aspects of clinical chart reviews, including
identifying and data mining patient lists, coordinating chart
provisions with reviewers, communicating results to education
- Organize and provide executive, management and front-line
initiatives and performance reporting and communication for any
- Supports implementation of market toolsets maintenance of
existing tool sets, such as point of care tools.
- Supports implementation of programs designed to ensure all
diagnosed codes and conditions are properly supported and submitted
to Health Plan partners.-- Programs include submission,
reconciliation, and electronic data submission.
- All staff members are to promote a positive and productive work
environment by acting maturely and responsibly, satisfactorily
performing his or her job responsibilities and conducting
themselves in a professional, courteous and respectful manner
toward fellow employees, physicians and patients.
- Must relate to other people beyond giving and receiving
instructions: (a) get along with co-workers or peers without
exhibiting behavioral extreme; (b) perform work activities
requiring negotiating, instructing, supervising, persuading or
speaking with others; and (c) respond openly and appropriately to
feedback regarding performance from a supervisor.
- Performs all duties in a manner which promotes and supports the
Core Values and Compact of The Everett Clinic.
- Integrates Lean principles, practices and tools to improve
operational efficiency, reduce costs and increase customer
- Frequently must follow written and oral instructions as well as
complete routine tasks independently.
- Completes annual compliance training on
Statement and signs Agreements.
- Ensures confidentiality of patient information following HIPAA
guidelines and TEC policies.
- Attends training to meet requirements of the job position and
as needed or mandated by TEC policies, Div. of Occupational Safety
& Health (DOSH), OSHA, L&I and other state/federal
- Has regular and predictable attendance.PREFERRED
QUALIFICATIONS:Knowledge, Skills & Abilities: Note that these
requirements are representative, but not all-inclusive, of the
knowledge, skill, and ability required to perform this job.
- Experience supporting risk adjustment activities in a large HMO
or provider organization
- Ability to interact effectively with C-Level employees across
- Knowledge of regulations related to Medicare Advantage,
Medicaid, Commercial risk adjustment
- Knowledge of claim coding and payment methodology utilized in
Medicare and Medicaid lines of business
- Ability to initiate and maintain cross-team relationships
- Excellent analytical and problem-solving skills
- Ability to effectively direct preparation of various financial
analysis and data mining activities
- Ability to effectively interface with staff, clinicians and
- Excellent teaming/interpersonal and verbal and written
communication skillsEducation: Bachelor's degree from a four-year
college and/or a professional certification requiring formal
education beyond a two-year college.----------Experience:
- 3-5 years minimum program coordination experience.
- 5+ years health care experience.
- Fluency in Microsoft applications.Preferred:
- 1-3 years minimum management experience.
- Background in supporting population health management and/or
risk adjustment activities and clinical informatics.
- Experience in analytics and data
analysis.------------------PHYSICAL AND MENTAL DEMANDS The physical
and mental demands described here are representative of those that
must be met by employees to successfully perform the essential
functions of this job.--PHYSICAL DEMANDS: While performing the
duties of this job, employees are regularly required to sit, walk
and stand; talk or hear, both in person and by telephone; use hands
repetitively to finger, handle, feel or operate standard office
equipment; reach with hands and arms; and lift up to 25 pounds.
Specific vision abilities required by this job include close
vision, distance vision and the ability to adjust focus.MENTAL
DEMANDS:While performing the duties of this job, employees are
regularly required to use written and oral communication skills;
read and interpret data, information and documents; analyze and
solve non-routine and complex office administrative problems; may
use math and mathematical reasoning; observe and interpret
situations; learn and apply new information or skills; perform
highly detailed work on multiple, concurrent tasks; work under
intensive deadlines with frequent interruptions; and interact with
managers, staff, customers, patients, the public and others
encountered in the course of work, some of whom may be dissatisfied
or abusive individuals.TYPICAL WORKING CONDITIONS:-- The work
environment characteristics described here are representative of
those an employee encounters while performing the essential
functions of this job.Typical office conditions and noise level is
usually quiet.-- Interaction with others is busy, constant and
occasionally interruptive.-- Work may be demanding at times.-- May
require ability to work irregular hours.Reasonable accommodations
may be made to enable individuals with disabilities to perform the
essential functions.CONTACT:-- Physicians, employees, patients,
public and vendors.Job descriptions represent a general outline of
job duties, functions and qualifications.-- They are not intended
to be comprehensive in nature.-- In addition, jobs evolve over time
and therefore their description may not reflect the precise nature
of the position at a given point in time.
Keywords: Optum, Tacoma , Risk Adjustment, Program Manager, Executive , Tacoma, Washington
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