Departmental Preferences:

• Strongly prefer certification in risk adjustment coding (CRC)
• Prior experience in medical record auditing (CMS, RADV, Part C IPM)
• Medicare risk adjustment experience
• Clinical knowledge/experience a plus

SUMMARY:

The Manager, Risk Mitigation is responsible to plan, organize, direct, control, and lead the assigned
business unit. This position specializes in development, planning, and leadership, and operates within broad objectives to ensure optimum utilization of capital, manpower, and equipment for the assigned business unit. The Manager, Risk Mitigation is responsible for oversight, strategy and execution of CMS audits for both Medicare Advantage and Commercial business.

EDUCATION:

Bachelor’s degree in a related field. Master’s degree in a related field preferred. Relevant combination of education and experience may be considered in lieu of degree. Continuous learning, as defined by the Company’s learning philosophy, is required. Coding Certification or progress toward certification is highly preferred and encouraged.

EXPERIENCE:

Seven (7) years of progressively more responsible experience in a health care environment with demonstrated technical experience that provides the necessary knowledge, skills, and abilities.
Knowledge of CMS Regulations as demonstrated by prior work experience. Three (3) years management or supervisory experience with direct reports in health care required. Experience in health care industry with payers, third party administrators, benefit consultants, or health care IT required.

SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:

• 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. MS Project preferred. JIRA is a plus.
• 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.

WORKING CONDITIONS:

Work is performed in an office setting with no unusual hazards. Travel may be required.
The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels
associated with performing the duties and responsibilities contained in this job description.
Candidates for the position stated above are hired on an “at will” basis. Nothing herein is intended to create a contract.
PAY RANGE: Actual compensation decision relies on the consideration of internal equity, candidate’s skills and professional experience, geographic location, market, and other potential factors. It is not standard practice for an offer to be at or near the top of the range, and therefore a reasonable estimate for this role is between $92,200 and $154,500.
EEO Statement: All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability

• 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.