• Risk Adjustment Revenue Manager (Remote)

    Marshfield Clinic (Marshfield, WI)


    Come work at a place where innovation and teamwork come together to support the most exciting missions in the world!

    Job Title:

    Risk Adjustment Revenue Manager (Remote)

    Cost Center:

    682891390 SHP-Strategic Finance

    Scheduled Weekly Hours:

    40

    Employee Type:

    Regular

    Work Shift:

    Mon-Fri; 8:00 am - 5:00 pm (United States of America)

    Job Description:

    The Risk Adjustment Revenue Manager is responsible for risk adjustment strategy and related revenue management for Security Health Plan’s Medicare, Affordable Care Act and Medicaid business. This individual provides development and implementation of programs and initiatives to improve the accuracy of the coding, including education; retrospective and prospective review processes; and vendor contract management; accountability for preparation for and management of the Centers for Medicare and Medicaid Services (CMS) and the Department of Health Services (DHS) auditing processes; management of encounter data processes; and management of applicable state and federal guidance. The Risk Adjustment Revenue Manager works collaboratively with Security Health Plan executives and leadership as well as Marshfield Clinic Health System (MCHS) executives and leadership to lead risk adjustment strategy and process.

    JOB QUALIFICATIONS

    EDUCATION

    **Minimum Required:** Bachelor’s Degree in Business Administration, Finance, Health Care Administration, Management or related field required.

    **Preferred/Optional:** Post graduate degree(s) desirable.

    EXPERIENCE

    **Minimum Required:** Five years of experience in risk adjustment or related area. Three years of experience in a management or leadership role and experience in the healthcare industry. Demonstrate a broad understanding of healthcare and health insurance. Demonstrate proficiency with verbal and written communication, strategic planning and business acumen.

    **Preferred/Optional:** Working knowledge of CMS and/or Medicaid risk adjustment methodologies.

    CERTIFICATIONS/LICENSES

    _The following licensure(s), certification(s), registration(s), etc., are required for this position. Licenses with restrictions are subject to review to determine if restrictions are substantially related to the position._

     

    **Minimum Required:** Certifications in professional coding and risk adjustment coding from American Academy of Professional Coders. State of Wisconsin driver’s license with an acceptable driving record.

    **Preferred/Optional:** None

     

    Marshfield Clinic Health System is committed to enriching the lives of others through accessible, affordable and compassionate healthcare. Successful applicants will listen, serve and put the needs of patients and customers first.

     

    Exclusion From Federal Programs: Employee may not at any time have been or be excluded from participation in any federally funded program, including Medicare and Medicaid. This is a condition of employment. Employee must immediately notify his/her manager or the Health System’s Compliance Officer if he/she is threatened with exclusion or becomes excluded from any federally funded program** **.

     

    Marshfield Clinic Health System is an Equal** **Opportunity/Affirmative** **Action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.