Centrum Health · 1 day ago
Sr. Manager, Risk Adjustment & Quality
Doral, FL
Full-time
Onsite
Senior Level
6+ years expCentrum Health is a value-driven healthcare company committed to transforming healthcare and creating a better care experience for all. The Sr. Manager of Risk Adjustment and Quality will manage a team responsible for billing and coding operations while ensuring compliance with regulatory requirements.
HealthcareHospitalDentalHealth CareMedicalPrimary and Urgent Care
Responsibilities
The core function of this role includes management of risk adjustment, medical records, coding, and billing operations
Lead a team to drive risk adjustment performance across Medicare Advantage, ACO, Medicaid, and ACA lines of business
Provide thought leadership in the continued development of the Risk Adjustment and Quality function, including collaboration with analytics and internal technology teams to develop a Risk Adjustment and Quality Suspecting Engine
Work closely with internal technical teams to develop in house tools to support Risk Adjustment operations
Provide leadership and overall program management for retrospective and prospective encounter facilitation, supplemental data submission, virtual visits, and in-office assessments
Collaborate with Actuarial and Analytics teams to design and implement suspecting and segmentation strategies for prospective and retrospective programs
Develop short-term, quick-win initiatives as well as long-term, analytics-driven gap-closure programs and tools
Communicate complex concepts to non-technical business stakeholders across the full business cycle—from question identification through results interpretation—including data integrity considerations
Ensure Centrum Health’s ability to meet federal and state regulatory compliance and reporting requirements, including RADV audits, on an annual basis
Perform other duties and responsibilities as assigned
This position will have direct and indirect supervisory responsibility for risk adjustment program execution and analytics functions
Occasional travel may be required
Qualification
Required
Bachelor's degree in mathematics, engineering, analytics, or healthcare-related fields, or equivalent experience
Six (6) or more years of experience in a healthcare Risk Adjustment–focused field
Five (5) years of experience working directly in primary care practices
Three (3) or more years of leadership experience managing and mentoring teams
Working knowledge of business intelligence tools and their application in driving business decisions
Bilingual in Spanish and English
Ability to lead and mentor a highly skilled team
Ability to frame and execute end-to-end analyses in collaboration with business and technical stakeholders
Expertise in advanced data analysis to identify opportunities and design programs to capture value
Experience managing third-party service providers, including TPAs and medical record/chart retrieval functions
Eager learner; collaborative partner; clear communicator; and detail-oriented analyst
Strong passion for empirical research and data-driven decision-making
Experience maintaining payer file integrations and developing performance dashboards using data from multiple reporting sources
Preferred
Experience with in-home and virtual engagement capabilities
Company
Centrum Health
Centrum Health provides medical, primary care, dental care, diagnostic, and laboratory services.
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
Tomas Orozco
Chief Executive Officer
Carlos A. Fernandez-D’Mant
Executive Vice President , Chief Growth Officer
Recent News
2024-04-10
Company data provided by crunchbase