Emergent Holdings · 11 hours ago
Manager, Risk Mitigation
United States
Full-time
Remote
Mid, Senior Level
$92K/yr - $154K/yr
7+ years expEmergent Holdings is seeking a Manager, Risk Mitigation to lead and oversee the assigned business unit. This role involves planning, organizing, and executing CMS audits for Medicare Advantage and Commercial business while ensuring optimal resource utilization and departmental effectiveness.
Health CareInformation ServicesInformation TechnologyInsuranceMedical
Responsibilities
Provides vision, strategy, leadership, planning, project coordination, and oversight for the execution of CMS mandated RADV Audits for Medicare Advantage and Commercial business
Manages activities for provider and facility reimbursement for medical record retrieval
Responsible for balancing workload to optimize the effectiveness of the department
Manages activities of a department including, but not limited to, planning, problem solving, staff development, and communication
Executes function/area objectives that support continuous improvement
Provides effective and efficient solutions to complex business problems
Provides high level oversight and leadership
Manages professional, exempt, and non-exempt non-bargaining and bargaining unit employees
Responsible for special projects and/or problem resolutions
Qualification
Required
Bachelor's degree in a related field
Seven (7) years of progressively more responsible experience in a health care environment with demonstrated technical experience
Knowledge of CMS Regulations as demonstrated by prior work experience
Three (3) years management or supervisory experience with direct reports in health care
Experience in health care industry with payers, third party administrators, benefit consultants, or health care IT
Ability to manage competing priorities and understand the downstream implications of shifting priorities
Demonstrated expertise in health payer market and deep knowledge of payer operations
Experience delivering product and/or projects to large-scale enterprises
Expertise in defining and prioritizing business requirements and validating product capabilities
Excellent organizational, communication, and presentation skills
Ability to facilitate the completion of work in a matrix environment
Word, Excel, PowerPoint experience required
Able to drive cross-functional coordination and alignment around initiatives to create competitive advantage in the marketplace
Ability to work effectively with senior leaders and functional teams to ensure success
Must demonstrate leadership ability and team building skills to effectively supervise professional and non-professional staff and interact with all levels of management
Ability to work with and empower others on a collaborative basis to ensure success of unit team
Ability to effectively exchange information, in verbal or written form, by sharing ideas, reporting facts and other information, responding to questions, and employing active listening techniques
Ability to effectively present budgetary and/or cost information and respond to questions as appropriate
Ability to establish workflows, manage multiple projects, and meet necessary deadlines
Preferred
Certification in risk adjustment coding (CRC)
Prior experience in medical record auditing (CMS, RADV, Part C IPM)
Medicare risk adjustment experience
Clinical knowledge/experience
Master's degree in a related field
Coding Certification or progress toward certification
Company
Emergent Holdings
Emergent Holdings’ elite team makes lives, companies and communities better! Emergent Holdings is driven by a singular goal — improving the health and safety of our customers and our communities.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
John S. Roberts
Executive Vice President, Emerging Markets & Chief Administrative Officer
Brittanie Benson
Human Resources Business Partner
Recent News
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2025-06-21
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