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Risk Adjustment Manager (Located in Denver, CO) Job in Denver, Colorado

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Job Title: Risk Adjustment Manager (Located in Denver, CO)

Employer:Physician Health Partners
Skills:Management skills,claims coding,auditing,risk adjustment,communication skills
Required Certifications:CPC
Required Experience:1 to 2 years
Preferred Experience:3 to 4 years
Location:1125 17th st, ste 1000 Denver 80202, CO, US
Date Posted:5/24/2019

Position Summary:  Responsible for hiring, training and developing staff to support the PHP Risk Adjustment program.  Supervises Risk Adjustment Educators and Risk Adjustment Program Support Coordinator to ensure department’s program is effective and meets the needs of client-providers.  Works in collaboration with other PHP external-facing departments (PR, Quality, Care Coordination) and support departments (Client Decision Support and IT) to ensure program implementation, data collection and performance reporting that assists practices in coding more effectively and accurately to maximize IPA revenue.  Obtains assistance from community experts, plans education and serves as a mentor/trainer to internal and external customers and vendors.


COMPETENCIES/Role-Specific Functions: 



Operates within the organization's formal and informal structures, builds allies and relationships across departments, uses allies to build consensus and create results, is appropriately diplomatic, understands others' roles and perspectives, can sell projects and ideas across the organization.

  • Collaborates and communicates with internal and external facing departments to align strategies which reflect current Risk Adjustment program services, development needs and organizational goals.



Recognizes problems and responds, systematically gathers information, sorts through complex issues, seeks input from others, addresses root cause of issues, makes timely decisions, can make difficult decisions, uses consensus when possible, communicates decisions to others.

  • Evaluates practice and staff performance and satisfaction to ensure decisions:  are supported by information collected from appropriate sources; meet the needs of departments involved; are communicated in a timely manner; and reflect timely, collaborative, thoughtful solutions.


C.      PLANNING  

Develops realistic plans, sets goals, aligns plans with company goals, plans for and manages resources, creates contingency plans, coordinates/cooperates with others.

  • Develops plan for staffing, training, evaluating and budgeting appropriate levels of support for the current and future plans for the Risk Adjustment program. 
  • Determines methods for evaluating and reporting resource needs and coverage during time off, turn over, etc.
  • Develops and measures methods to understand and improve interrator reliability surrounding record reviews and education messaging. 



Defines roles and responsibilities, applies clear/consistent performance standards and provides feedback and coaching. Handles performance problems decisively and objectively, provides guidance and assistance to improve performance, rewards hard work and risk taking, motivates, challenges and develops employees, delegates effectively.

  • Completes regularly scheduled one on ones with Risk Adjustment staff to discuss current objectives, goals, obstacles and assistance needed to continue to grow within the department.
  • Provides materials,  answers questions and responds to requests from both internal and external partners. 
  • Supervises risk adjustment educators and program support staff to ensure work is timely and  complete.
  • Identifies and communicates to leadership (director) any additional training needs for department to ensure integrity of services provided.



Builds customer confidence, is committed to increasing customer satisfaction, sets achievable customer expectations, assumes responsibility for solving customer problems, ensures commitments to customers are met, solicits opinions and ideas from customers, responds to customers.

  • Acts as a primary resource for PHP staff, physicians and practice staff to answer questions regarding risk adjusting coding and Medicare coding guidelines and code updates. 
  • Develop high level, interactive relationships with client practices in order to maintain engagement and appropriate staff assignments. 
  • Provide or arrange coverage support to practices when assigned risk adjuster educator is not available.



Understands duties and responsibilities, has necessary job knowledge, has necessary technical skills, understands company mission/values, keeps job knowledge current, is in command of critical issues

  • Understands and provides staff training regarding the ongoing development and implementation of the Risk Adjustment program, including planning resources and assignments to meet client needs.
  • Researches and/or uses department, CMS and UnitedHealthcare materials to support training and ensure compliance.
  • Other duties as assigned.


Qualifications (Education/Experience/Knowledge/Skills): 

  • Education: Associates or Bachelors’ degree required.
  • Professional Coder Certification (CPC) required.
  • Previous auditing of clinical data in physician offices or medical facility required.
  • Minimum three years’ experience in a medical office, health plan or hospital system working with electronic medical records.
  • 2 years supervisory experience; prefer experience supervising risk adjustment staff and programs.
  • Knowledge of health care insurance claims practice and compliance.
  • Knowledge of Medicare rules and guidelines.
  • Knowledge of Claims Coding (CPT, HCPCS, Revenue Codes, ICD-9/ICD-10, UB92/HCFA 1500).
  • Knowledge of risk adjustment categories and hierarchy.
  • Knowledge of MS Office Suite, other software programs and internet based applications as needed to fulfill position duties.
  • Skilled in synthesizing data and questions to communicate a cohesive educational training program.
  • Skilled in presenting and explaining data in a clear, concise manner.
  • Skilled in interpreting Medicare rules and changes.
  • Skilled in responding to practice inquiries in a timely and accurate manner.
  • Skilled in working collaboratively with various parties to communicate an accurate and meaningful reporting package for practices.
  • Able to work effectively with physicians, practice staff, health plan/other external parties and PHP multi-disciplinary team to streamline efforts to meet Risk Adjustment goals.
  • Able to work with sensitive data and relay potential issues or concerns in a diplomatic manner.
  • Able to multi-task and meet deadlines.
  • Able to work with external parties to incorporate data elements into reporting package.
  • Able to communicate findings in a clear, concise manner, both internally and externally.
  • Required Licensure or Certification for this position must be maintained by the employee as defined by the company policies and procedures.
  • A valid unrestricted Colorado drivers’ license.  Reliable and insured vehicle.
  • Mobile Device for work purposes as defined by the company policies and procedures.

Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.  While performing the duties of this Job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear.  The employee is frequently required to stand; walk; reach with hands and arms and stoop, kneel, crouch, or crawl.  The employee is occasionally required to climb or balance. The employee must regularly lift and/or move up to 25 pounds.  Specific vision abilities required by this job include close vision and ability to adjust focus.

Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.  The noise level in the work environment is usually moderate.


Please apply at http://j.brt.mv/ATS/jb.do?reqGK=27236230&portalGK=5132&refresh=true 


Email resume to HR@phpmcs.com

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