Supervisor Strategic Risk Adjustment And Quality

Highmark Health

Base: $86,400.00 - $138,600.00; bonus/equity: not ...
Fully remote
Risk adjustment coding expertise
Hedis quality measure management
Government compliance guidelines
This role is responsible for developing plans and managing activities to support Risk Adjustment and Quality/HEDIS initiatives across all product lines

Job Summary

  • This role is responsible for developing plans and managing activities to support Risk Adjustment and Quality/HEDIS initiatives across all product lines.
  • The incumbent will oversee daily operations, manage staff productivity, and ensure accurate diagnosis coding while maintaining compliance with government regulations.
  • Key responsibilities include conducting specialized provider office visits, leading audits, and implementing strategic improvements to enhance patient care and satisfaction.

Matching Summary

This role is responsible for developing plans and managing activities to support Risk Adjustment and Quality/HEDIS initiatives across all product lines.

Salary

Base: $86,400.00 - $138,600.00; Bonus/Equity: Not specified; Benefits: Not specified

Skills & Requirements

Must-have

  • Risk Adjustment Coding expertise
  • HEDIS Quality Measure management
  • Government compliance guidelines
  • ICD10 CPT HCPCS code review
  • Medical record documentation oversight
  • Provider office visit coordination
  • Staff performance management

Nice-to-have

  • Total Quality Management concepts
  • Project management experience
  • Mentoring and coaching skills
  • Cross-functional collaboration
  • Data analysis capabilities
  • Innovation in healthcare processes

Key Requirements

  • Bachelor's Degree in Health related field or RN/LPN license
  • 6 years combined experience in Risk Adjustment, HCC coding, HEDIS
  • 3 years experience with government markets and compliance guidelines
  • 1 year in a management or leadership role
  • Required certifications: CPC, CCS, RHIA, or CRC
  • Preferred: 3 years clinical nursing role (RN or LPN)

Work Rights

Not specified

Tailored Resume

Cover Letter