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Job Summary
We are looking for a skilled and experienced manager for ACA Risk Adjustment to lead our efforts in RADV IVA for BCBSTX.This position will ensure compliance with regulatory requirements and risk adjustment revenue for the ACA market.
The ideal candidate will have a deep understanding of risk adjustment methodologies, data analysis, claims and healthcare operations.
- Lead and manage the ACA RADV IVA program for BCBSTX, driving performance for diagnosis validation and improvements.
- Develop and implement strategies to address documentation and coding gaps, working closely with providers and staff.
- Analyze and interpret data to identify trends, opportunities for improvement, and areas of risk.
- Collaborate with cross-functional teams to develop and implement training programs and initiatives.
- Stay current on changes in regulatory requirements and industry best practices.
JOB REQUIREMENTS:
-Bachelor’s degree and five (5) years’ provider contracting experience
OR
Nine (9) years’ managed care experience including five (5) years’ provider contracting experience.
-Extensive knowledge of provider and facility contracting, products, and claims/processing systems.
-Leadership skills to oversee staff, implement initiatives, and work across the company to resolve issues.
-Negotiation skills.
-Relationship building skills.
-Knowledge of marketplace.
-Meet deadlines and work well under pressure.
-Verbal and written communication skills to interact with all levels of corporate personnel and providers.
-PC proficiency to include Microsoft Office.
-Analytical skills.
-Project management skills to lead or participate in projects or initiatives.
-Ability and willingness to travel within assigned areas of responsibility, including overnight stays
PREFERRRED REQUIREMENTS:
-Minimum of 3 years of experience in risk adjustment management, preferably in a healthcare setting.
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HCSC Employment Statement:
HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
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