[Hiring] Medicare Risk Adjustment Manager @CVS Health

Role Description

This is an individual contributor role.

As the Manager, Risk Adjustment, you will be responsible for leading Risk Adjustment for the Southeast Region, specifically in GA/Gulf States. Responsibilities include:

• Maintaining and improving risk adjustment accuracy by partnering closely with leadership from key value-based providers.
• Driving risk coding improvement activities within the region in collaboration with national and local risk adjustment teams.
• Managing medical record collection, provider collaboration, and data sharing.
• Conducting general coding education and related activities.
• Performing other activities as assigned.

This position requires strategic thinking and the ability to act independently when working with providers. You will report to the Lead Director of Risk Adjustment for the Southeast Region.

Qualifications

• 5+ years of experience with one or more of the following methodologies: risk adjustment, clinical quality, or healthcare quality improvement.
• Certification in coding (CPC, CRC, RHIA, etc. through AAPC or AHIMA).
• Experience working in provider offices, accountable care organizations, and/or value-based provider relations.
• Strong time management, project management, change management, organizational, research, analytical, negotiation, communication, and interpersonal skills.
• Strong proficiency in Microsoft Office applications (Outlook, Word, Excel, PowerPoint, etc.), including experience running web-based meetings.
• Ability to manage ambiguity and work in a fast-paced environment.
• Excellent stakeholder relationship management skills.

Requirements

• 7+ years of experience in risk adjustment, clinical quality, or healthcare quality improvement preferred; experience supporting provider-based or value-based initiatives preferred.
• Candidates residing in Georgia or the Southeastern United States are preferred.
• Bachelor’s degree preferred, or a combination of relevant professional experience and education.

Benefits

• Comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families.
• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs and other resources, based on eligibility.