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Regional Senior Specialist, Risk Adjustment (REMOTE - FL, SC, NY & WI)

Molina Healthcare Job ID 2006473
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Job Description
Job Summary
The Regional Senior Specialist, Risk Adjustment is responsible for managing and driving all activities related to accurately capturing risk score performance. This Sr. Specialist will support these states: FL, SC, NY & WI, with a primary responsibility of engaging with FL providers and groups on coding education and documentation guidelines. Bilingual in Spanish would be a plus as there is a large makeup of Spanish speaking providers in FL.

• Develops and manages implementation of risk adjustment initiatives and coordination efforts.
• Develops risk adjustment strategy in conjunction with Corporate Risk Adjustment Department
• Escalates problems promptly that would prevent goals from being achieved; reports non-compliance
• Assists in removing barriers to contacting members
• Works with HP and Risk Adjustment Analytics Reporting to monitor completed provider and member assessments to ensure annual goals are achieved
• Monitors performance and evaluates results of risk adjustment initiatives
• Innovative thinker and ability to independently implement ideas
• Excellent influencing and negotiating skills
• Assists in the creation of target lists in preparation for prospective/retrospective reviews
• Abstracts records based on dates of service within the current base period and uploads results into appropriate data repositories
• Works with the HEDIS and Coding Teams to ensure timely receipt of records
• Works with vendors and participates in monthly meetings
• Develops, implements, and manages all project plans related to initiatives to improve plan risk score performance.
• Monitors performance and evaluate results of risk adjustment initiatives.
• Oversees the entire risk adjustment process including, but not limited to, tracking, proofing, following through corporate approval process, and any necessary provider follow up
• Assists with relationship building strategies and opportunities for financial growth through risk score improvement initiatives.
• Identifies, develops and implements provider/member programs specific to risk score improvement.
• Research and resolve contact information discrepancies for various member populations
• Work with Providers and Corporate RAMP for completion of members Annual Comprehensive Exams
• Works closely with Provider Services staff to outreach and educate the provider network on proper coding practices. Acts as a subject matter expert for providers regarding coding and risk adjustment.
• Other duties as assigned.
Job Qualifications
Required Education
Associate's Degree
Required Experience
3-4 years' experience in Managed Care Programs, preferably Medicaid and Medicare.
Experience working with providers and affecting change and outcomes
Preferred Education
Bachelor's Degree
Preferred Experience
Minimum three years experience in supporting risk adjustment activities and improving risk score performance and provider education
Preferred License, Certification, Association
CPC (Certified Professional Coder), CSS (Certified Coding Specialist), or CRC (Certified Risk Coder)

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

About Us

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Job Type: Full Time Posting Date: 01/21/2021


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