We are recruiting for a Manager, Risk Adjustment - DHMP to join our team!

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　　DepartmentManaged Care Administration

　　Job Summary

　　The Risk Adjustment Manager ("Manager") works under minimalsupervision to monitor the revenue made from health exchanges, individualand small group health insurance markets, Medicaid and Medicare. TheManager oversees Medicare and Affordable Care Act/Exchange risk adjustmentand translates DHMP strategies into operational plans and direction and theypertain to revenue, numerous quality measures and reporting submitted toregulaReporting to the Director of Actuarial Services, the Manager is a subjectmatter expert who ensures the accurate, timely and compliant execution ofall Risk Adjustment activities and achievement of related revenue targets.The Manager interacts with all levels of management, employees acrossDHHA/DHMP, external consultants and Federal and State representatives tocoordinates activities with appropriate functional areas including MedicalManagement, Quality, Pharmacy, Member Services, Operations, etc..Creates, analyses, monitors and manages the strategy and operations ofMedicare and Affordable Care Act/Exchange Risk Adjustment team for DenverHealth Medical Plan including creating Dashboards and standards forsubmissions reconciliation and risk score metric tracking.Supervises a team of analysts and medical coders to complete the objectives ofthe risk adjustment team.

　　Essential Functions:

　　Strategy and PlanningPartners with contracted service providers, internal departments and DHMPleadership to plan the strategic direction of risk adjustment initiatives tofacilitate achievement of complete and accurate diagnosis capture andsustainable business performance to achieve organizational goals. (25%)Operations ManagementManages the development, implementation, monitoring and oversight ofprograms, processes and operations to improve risk adjustment performanceand accuracy of risk adjustment data collected and submitted to State andFederal regulators. (20%)Program DevelopmentDevelops, implements, and maintains programs to ensure capture of datarelated to Risk Adjustment revenue, including Encounter Data, variousquality measures and member status related to revenue. (15%)Vendor and Coding ManagementOversees Chart Review, Home Health and Encounter Data vendors and createsstrategic plans for risk capture activities and assess ROI for risk adjustmentprogram activities; develops effective relationships with key providergroups (internal and external). (10%)Data Analysis and ReportingEnsures accurate development, analysis and reporting of key risk adjustmentmetrics, as well as overseeing analyses of new legislation and regulationsregarding Risk Adjustment; evaluates and oversees the development andimplementation of all risk adjustment program changes. Incorporates changesand requirements into strategy. Develops and monitor STAR and other qualitymetrics and works with business owners to ensure goals are achieved. (10%)Uses analytics to define Risk Adjustment focus and optimizes quality and riskadjustment metrics opportunities. Leads the development of key analytics anddata to support risk adjustment financial forecasts, analysis and reportingto engage key stakeholders and communicate program results to theorganization. (10%)Develops performance targets for both internal and external parties andensures that performance targets are set and included in contracts whereappropriate. Tracks progress against stated goals and drive to attainment.Cross Functional Coordination (5%)Coordinates with Quality Improvement (teams to ensure co rdination ofefforts; collaborate to ensure delivery and integration of risk adjustmentand quality programs. (5%)Education:

　　Bachelor's Degree RequiredWork Experience:

　　4-6 years Combination of five years Medicare Risk Adjustment and/or ManagedCare or Health Care experience required.Licenses:

　　Knowledge, Skills and Abilities:

　　Solid knowledge of the industry and cross-functional work experiences in theareas health insurance finance, medical economics, actuarial,underwriting, and/or risk adjustment.Analyzing Data or Information - Identifying the underlying principles,reasons, or facts of information by breaking down information or data intoseparate partsAdvanced knowledge of risk adjustment coding and CMS data validation.SQL and/or SAS and TableauExpertise in reconciliation and revenue enhancement principles.Proven ability to make sound decisions relative to the reconciliation andrevenue enhancement of Medicare Advantage products.Demonstrated interpersonal, communications and team building skills.Active Listening - Giving full attention to what other people are saying,taking time to understand the points being made, asking questions as