JOB SUMMARY
The Risk Adjustment Revenue Director is a finance leader responsible for risk adjustment strategy and related revenue management for Sanford Health Plan’s Medicare, Affordable Care Act and Medicaid business and reports to the Senior Director, Chief Actuary. This individual is directly responsible for the development and implementation of programs and initiatives to improve the accuracy of the coding, including education; retrospective and prospective review processes; and vendor contract management; accountability for preparation for and management of the Centers for Medicare and Medicaid Services (CMS) and the Department of Health Services (DHS) auditing processes; management of encounter data processes; and management of applicable state and federal guidance. The Risk Adjustment Revenue Director works collaboratively with Sanford Health Plan executives and leadership as well as Sanford Health Services executives and leadership to lead risk adjustment strategy and process.
JOB QUALIFICATIONS
EDUCATION
For positions requiring education beyond a high school diploma or equivalent, educational qualifications must be from an institution whose accreditation is recognized by the Council for Higher Education and Accreditation.
Minimum Required: Bachelor’s Degree in Business Administration, Finance, Health Care Administration, Management or related field required.
Preferred/Optional: Post graduate degree(s) desirable.
EXPERIENCE
Minimum Required: Ten years of experience in risk adjustment or related area. 15 years of experience in a management or leadership experience. Demonstrate a broad understanding of healthcare and health insurance. Demonstrate proficiency with verbal and written communication, strategic planning and business acumen.
Preferred/Optional: Fifteen years of experience in a management or leadership role with working knowledge of CMS and/or Medicaid risk adjustment methodologies.
CERTIFICATIONS/LICENSES
The following licensure(s), certification(s), registration(s), are required for this position. Licenses with restrictions are subject to review to determine if restrictions are substantially related to the position.
Minimum Required: American Academy of Professional Coders - Certified Professional Coder certification and/or American Academy of Professional Coders - Certified Risk Adjustment Coder certification.
Preferred/Optional: None
Marshfield Clinic Health System is committed to enriching the lives of others through accessible, affordable and compassionate healthcare. Successful applicants will listen, serve and put the needs of patients and customers first.
Exclusion From Federal Programs: Employee may not at any time have been or be excluded from participation in any federally funded program, including Medicare and Medicaid. This is a condition of employment. Employee must immediately notify his/her manager or the Health System’s Compliance Officer if he/she is threatened with exclusion or becomes excluded from any federally funded program.Marshfield Clinic Health System is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.