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 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.
• 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).