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Operations Manager - Risk Adjustment

Company: Wolters Kluwer
Location: Madison
Posted on: January 16, 2022

Job Description:

Operations Manager - Risk AdjustmentR0021001Madison, WI or RemoteThe Operations Manager - Risk Adjustment is responsible for leading the development and execution of Risk Adjustment programs and overseeing the management of Risk Adjustment processes and initiatives. This position will begin as a hands-on manager with the unique opportunity to build and grow the operations organization and to build and lead a team of Risk Adjustment specialists. The role will drive operational strategies and best practices to produce successful Risk Adjustment outcomes related to risk scores, and improved accuracy. This position will develop and implement tools and metrics to ensure optimal performance, serve as a liaison to reduce the administrative burden for all new contracts, assist the client in monitoring performance and distribute reports to track Key Performance Indicators. This position will hire, coach, develop, and assess new and existing team members.***This position can work from a remote home office or base out of most WK locations in the U.S. post-Covid.The business this position sits within has significant office presences in Denver, CO and Madison, WI.ESSENTIAL DUTIES AND RESPONSIBILITIESManage the day-to-day activities of Risk Adjustment operations, including but not limited to coordinating the Risk Adjustment data flow to and from vendors, establishing weekly meetings, and building current performance reports.Capable of both understanding the big picture and getting into the details to execute, you'll be creating a process and executing to generate the workflow and operational processes required to support the launch of the Risk Adjustment product and subsequent client engagement. -Handle special projects and new implementations as well as prepare presentations and reports to be distributed internally and externally to clientsManage regular client meetings regarding quality results, production with a focus on continuous improvementMaximize ROI by monitoring and tracking performance against current agreements and by ensuring operational performance of vendor services.Develop a robust set of risk adjustment tools and enablement strategies such as coding and documentation education, reporting on key risk adjustment metrics, and integrating the risk adjustment activitiesDemonstrate expectation for continuous quality improvement by focusing on data, processes, procedures and outcomesPerform other related duties, tasks, and responsibilities as needed or directed.JOB QUALIFICATIONSEducation:Bachelor's degree preferred, or equivalent experienceMaster's degree a plusRequired Experience:5+ years of experience working in Healthcare (Payors, Providers, or Vendors) required, 10+ years preferred2+ years of Risk Adjustment experience required, 4+ years preferredProficient with MS Office productsPreferred Experience, Knowledge, Skills, Abilities or Certifications: -Operational experience at a coding vendor preferred -Experience managing metrics and productivityExperience in an organization using computer assisted coding applications, encoders, and NLP programsProficient in analyzing dataKnowledge of Risk Adjustment payment models and programs (e.g. Medicare, Commercial & Medicaid), HIPAA compliance, ICD-10-CM coding, guidelines, and industry established policies & proceduresAbility to understand/interpret metrics, data and information; and to communicate ideas and concepts effectively.Ability to effectively manage staff, processes, and programs.Excellent communication skills, (verbal, written, interpersonal) with all types of audiences.Customer focused, dependable and collaborative; client-facing collaborationDetail oriented, strategic thinker experienced decision-maker with outstanding follow through and execution of prioritiesExcellent organizational, critical thinking, and problem-solving skillsTravel Requirements:Some travel required, can be up to 25%SummaryLocation: USA - Madison, WI, Junction Rd; USA-AZ-Work from Home; USA-MI-Work from Home; USA-IL-Work from Home; USA-DC-Work from Home; USA-WI-Work from Home; USA-FL-Work from HomeType: Full time

Keywords: Wolters Kluwer, Madison , Operations Manager - Risk Adjustment, Executive , Madison, Wisconsin

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