Manager, Risk Adjustment

Location : Santa Clara Family Health Plan - San Jose, CA 95119 - Providing effective leadership to attract and retain top talent to drive business results, including recruiting, interviewing, and hiring.

• Developing a high performing department culture and staff. This includes setting the standard for staff / peers and motivating employees to maximize organizational goals and objectives.
• Effectively assimilating, training and mentoring staff and (when appropriate), cross training existing staff and initiating retraining.

This includes coaching to help increase skills, knowledge and (if applicable) improve performance.

• Setting goals and planning, assigning, and directing work consistent with said goals. This includes responding to employees needs, ensuring they have the necessary resources to do their work.
• Appraising performance, rewarding and disciplining employees, addressing complaints and resolving issues. This includes providing regular and effective feedback to employees and completing timely and objective performance reviews.

REQUIREMENTS Required (R) Desired (D)

The requirements listed below are representative of the knowledge, skill, and / or ability required or desired. - Bachelor's Degree in Business Administration, Health Care, Economics, Finance, Policy, or related field. (R)

• Masters Degree in Business Administration, Health Care, Economics, Finance, Policy, or related field . (D)
• Minimum of five years in health care with three years in risk adjustment experience working for or in support of Managed Care Organizations, preferably at a Medicare Advantage plan.
• Minimum three years of progressively responsible experience in a supervisory role. (R)
• Knowledge of health care coding (CPT-4, HCPCS, ICD-9-CM, ICD-10CM and modifiers) and billing systems. (R)
• Understands the rationale behind the RA payment structure, concept behind current RA methodology, how current work processes impact RA, and future trends of RA. (R)
• Takes the initiative to proactively resolve issues, address concerns, identify potential risks, and improve overall processes and outcomes.

Remain flexibility in a changing work environment and priorities. (R)

• Strong project management skills with the ability to manage projects from conception to conclusion, including resource allocation, budgets, and priority changes. (R)
• Excellent communication skills, including the ability to express oneself clearly and concisely across all levels of the organization, and with external constituents, over the telephone, in person, in presentations or in writing . (R)
• Ability to assume responsibility and exercise good judgment when making decisions within the scope of the position. (R)
• Working knowledge of and the ability to efficiently operate all applicable computer software, including a working knowledge of, and proficiency in, MS Office Suite applications, including Outlook, Word, Excel, PowerPoint, and relevant software. (R)
• Strong work ethic, able to multi-task, and commitment to multi-faceted environment. (R)
• Ability to facilitate meetings and give presentations to management and staff. (R)
• Ability to understand, evaluate, interpret, and apply rules, laws, regulations, program requirements, and industry guidance, and adjust direction as necessary to comply with said regulatory requirements. (R)
• Ability to gather and analyze data, organize / prioritize work, and coordinate multiple projects simultaneously. (R)
• Ability to think creatively and strategically, using strong analytical skills, to think and work effectively under pressure, and to appropriately prioritize and complete tasks within established timeframes. (R)
• Maintain valid California drivers license and acceptable driving record, in order to drive to and from offsite meetings or events;

or ability to use other means of transportation to attend offsite meetings or events. (R)

PHYSICAL REQUIREMENTS

• Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation. Mobility Requirements : regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies;
• and sit or stand for extended periods of time; (R) Lifting Requirements : regularly lift and carry files, notebooks, and office supplies that may weigh up to 20 pounds;
• R) Visual Requirements : ability to read information in printed materials and on a computer screen; perform close-up work;
• clarity of vision is required at 20 inches or less; (R) Dexterity Requirements : regular use of hands, wrists, and finger movements;
• ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment (R) Hearing / Talking Requirements : ability to hear normal speech, hear and talk to exchange information in person and on telephone;
• R) Reasoning Requirements : ability to think and work effectively under pressure; ability to effectively serve customers;

decision making, maintain a concentrated level of attention to information communicated in person, by telephone, and electronically throughout a typical workday; attention to detail.