Manager Risk Adjustment Quality Control
DescriptionSHIFT: Day Job
Be part of an extraordinary team
We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
Build the Possibilities. Make an extraordinary impact.
Remote opportunity - OH, IN, KY and TN preferred. Other locations may be considered
Responsible for ensuring the overall success of all Medicare Revenue Management programs to enhance the revenue we receive from the Center for Medicare and Medicaid Services (CMS) by proving our population with Medicare Risk Programs across the enterprise.
How you will make an impact:
- Manages the day-to-day operations for risk programs including provider education, vendor quality, audits, and acting as a SME on coding.
- Develops metrics, policies, and procedures in support of required deliverables and validation of programs' ROI while ensuring the programs are in compliance with CMS program requirements.
- Hires, trains, coaches, counsels, and evaluates the performance of direct reports.
Requires a BA/BS in a related field and a minimum of 5 years of management experience in a managed care setting, or any combination of education and experience, which would provide an equivalent background.
Preferred skills, capabilities, and experiences:
A Master's degree is preferred; the ability to travel may be required; extensive risk adjustment experience is also strongly preferred with a focus on CMS audit experience.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs, and financial education resources, to name a few.
The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Anthem approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state, and local laws.
Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact [email protected] for assistance.
Please be advised that Anthem only accepts resumes from agencies that have a signed agreement with Anthem. Accordingly, Anthem is not obligated to pay referral fees to any agency that is not a party to an agreement with Anthem. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Anthem.