Medicare Risk Program Manager

Medicare Risk Program Manager

Requirements

• Bachelor’s degree or direct and applicable work experience.
• 4+ years of related healthcare industry experience.
• Experience in the development & management of healthcare-related programs, which includes leading projects from ideation through execution and working in a highly matrixed environment with both internal and external partners.
• Knowledge of CMS rules and requirements of Medicare Advantage Health Plans.
• Demonstrated ability to think strategically to ensure program success.
• Demonstrated experience influencing stakeholders.
• 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.
• Self-starter motivated by the opportunity to work in fast-paced environments and driven by measurable outcomes. Effective time management with flexibility and adaptability to change.
• Strong organization, time management, and prioritization skills. Ability to manage multiple projects while adjusting to changing priorities and business needs.
• Collaborative approach to work with and ability to partner with different business areas.
• Proficiency with the Microsoft Office Suite.

Responsibilities

• Manage risk adjustment programs.
• Support 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.
• Drive success on coding accuracy and risk adjustment programs.
• Partner alongside Wellmark and joint venture team members focused on program management, analytics, provider performance, and more to drive change and progress.

Preferred Qualifications

• 2+ years of experience in managing Medicare Advantage Risk Adjustment programs.
• Knowledge of industry standard ICD-10-CM and CPT coding principles.
• Certified Risk Adjustment Coder (CRC).