The Manager, Risk Adjustment Operations is accountable for overseeing the management of Risk Adjustment processes and initiatives within a designated community. This position is a full time on-site role in San Jose, CA. Could eventually lead to a Hybrid schedule.

· Strategic, operations, and process management

· Teammate management

· Data mining and analysis

· Oversight of physician reviewers and the review program

· Partnership with Senior Director, Risk Adjustment Operations

ESSENTIAL FUNCTIONS:

· Consistently exhibits behavior and communication skills that demonstrate Optum’s commitment to superior customer service, including quality, care and concern with each and every internal and external customer

· Collaborates with regional management on key physician activities and Provider Relations and IPA liaisons on risk adjustment activities

· Interacts closely with central management by collaborating on development of regional programs and disseminating, managing, and overseeing central initiatives and data reporting to key stakeholders

· Interprets and provides feedback on CMS regulations and HCC risk adjustments reimbursement methodology

· Ensures dissemination of clinical/reimbursement information to all key stakeholders

· Acts as a resource on topics related to the clinical component of Medicare billing and Hierarchical Condition Coding in partnership with the regional risk adjustment clinician leads

· Identifies educational needs and meets these needs using both internal and external resources

· Collaborates in identifying targets for improvement and evaluates the results of interventions

· Helps to identify further opportunities for diagnosis evaluation

· Assists in evaluating effectiveness of each activity associated with the program

· Reviews and evaluates team performance for productivity and inter-rater reliability

· Assists in setting priorities for regional risk adjustment team

· Coordinates the orientation of new teammates -including Advanced Care Practitioners (ACPs) in collaboration with the Regional Director

· Oversees coordination of physician offices and embedded ACP schedules

· Monitors embedded APC productivity and reimbursement.

· Works with Provider Relations department to facilitate dissemination of information to providers

· Tracks and facilitates PCP payments related to special incentives implemented by the leadership team

· Monitors ACP productivity and quality / productivity incentives

· Oversees quality of work provided by administrative support staff

· Participates in process improvement projects related to work performed Orients new staff and provides training to teammates on work processes

· Uses, protects, and discloses Optum patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards

· Performs additional duties as assigned

EDUCATION:

Bachelor's degree from a four-year college and/or a professional certification requiring formal education beyond a two-year college

Master’s degree preferred

EXPERIENCE:

Minimum: 3 to 5 years’ experience in project management, health informatics, operations, and/or Medicare billing

· You will be asked to perform this role in an office setting or other company location, however, may be required to work from home temporarily due to space limitations.

KNOWLEDGE, SKILLS, ABILITIES:

· Strong clinical background with both acute care and chronic disease state management experience

· Strong Information Technology background

· Proficient user of MS Office Suite including intermediate to high-end user of Microsoft Access and Excel

· Strong understanding of the principles governing healthcare reimbursement including ICD-10 / CPT coding

· Excellent organizational, critical thinking, and problem-solving skills

· Excellent verbal and written communication skills

· Ability to effectively interface with staff, clinicians and management

· Ability to effectively manage a small team of medical assistants, outreach coordinators, and project coordinator

ON SITE POSITION

Job Type: Full-time

Pay: $92,901.00 - $125,072.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Employee discount
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Supplemental pay types:

• Bonus pay

COVID-19 considerations:
We follow the Santa Clara County Public Health Guidelines for Covid.

Ability to commute/relocate:

• San Jose, CA 95131: Reliably commute or planning to relocate before starting work (Required)

Experience:

• Project management: 1 year (Required)
• Microsoft Office: 1 year (Required)
• ICD-10: 1 year (Required)
• Microsoft Access: 1 year (Required)
• Management: 1 year (Required)

Work Location: One location

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