A leading healthcare company headquartered in Denver, CO is looking to hire a Senior Manager, Compliance Risk Adjustment. The role will report to the Director of Compliance and be responsible for overseeing risk adjustment compliance for CMMI and Medicare Advantage programs.
Responsibilities:
- Lead the compliance risk adjustment and revenue cycle compliance monitoring and auditing plans
- Develop, implement, and maintain all risk adjustment related initiatives, policies and procedures, and training and education programs
- Design and implement compliance monitoring data analytics supporting revenue cycle and risk adjustment
- Spearhead quarterly coding audit process and reporting
- Manage annual compliance risk assessment process
- Design and implement billing, coding, and risk adjustment related policies
- Lead oversight of risk adjustment vendors or other related 3rd parties
- Lead RAD-V and RAC audit preparedness (internal mock audits and external audit response)
Requirements
- Bachelor's Degree
- 5+ years of healthcare compliance experience
- Strong compliance risk adjustment experience
- Knowledge of healthcare laws and regulations including False Claims Act, Anti-Kickback Statute, Stark Law, etc.
- Familiarity with medical coding including ICD-10 and HCC risk adjustment coding
- Experience overseeing audits
