Manager Risk Adjustment Operations
Manager Risk Adjustment Operations
Employer Active
Job Alert
You will be updated with latest job alerts via email
Share
Job Alert
You will be updated with latest job alerts via email
$ 109000 - 185300
1 Vacancy
Job Description
Workforce Classification:
HybridJoin Our Team: Do Meaningful Work and Improve Peoples Lives
Our purpose to improve customers lives by making healthcare work better is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare.
To better serve our customers we are fostering a culture that emphasizes employee growth collaborative innovation and inspired leadership. We are dedicated to creating an environment where employees can excel and where top talent is attracted retained and thrives. As a testament to these efforts Premera has been recognized on the 2025 Americas Dream Employers list. In 2024 Newsweek honored Premera as one of Americas Greatest Workplaces Americas Greatest Workplaces for Diversity and Americas Greatest Workplaces for Mental Wellbeing. Additionally in 2024 Forbes ranked Premera among Americas Best Midsize Employers for the fourth time.
Learn how Premera supports our members customers and the communities that we serve through our Healthsource blog: you an experienced leader with a strong background in Risk Adjustment Operations We invite you to join our team as the Manager of Risk Adjustment Operations where you will lead our core operations team. In this role you will be responsible for overseeing submissions audits and compliance activities across our Individual Small Group and School Employees Benefit Board (SEBB) lines of business as well as all medical record retrieval for risk adjustment and some retrieval support for quality/HEDIS.
As a key member of our team you will develop and execute strategies aimed at ensuring accurate submissions error remediation and priority claims processing. You will collaborate effectively with various departments and vendors to guarantee compliant timely and efficient tactical deployment. Additionally you will manage vendor relationships and oversee vendor management processes. Your responsibilities will include directing the endtoend medical record retrieval program involving remote EMR access from multiple provider systems and issuing direct letter requests to providers in support of Quality and Risk Adjustment initiatives.
Join this mission driven and passionate team in our pursuit of making healthcare work better.
What youll do:
- Supervise a team of individual contributors and a Medical Record Retrieval Team Lead as well as seasonal contingent workers. This includes hiring coaching and providing performance feedback.
- Ensure compliance with CMS regulatory requirements and manage claims enrollment and data submissions.
- Oversee compliance with WA Health Care Authority submission requirements.
- Manage annual deliverables and timelines for HHSRADV audits including executive leadership reviews and approvals.
- Support MARADV audit deliverables and timelines and other ACA MA and SEBB audits in partnership with Compliance.
- Manage medical record retrieval efforts for various lines of business ensuring records are routed to coding queues and improving retrieval program efficiency.
- Perform vendor management and contracting activities including sourcing negotiation implementation and oversight of vendor services.
- Conduct program reporting on project status risks and outlook for senior leadership and recommend action steps based on analytic results.
- Ensure risk adjustment submissions and audit processes are compliant with regulatory requirements and not impacted by enterprise changes.
- Implement management control processes to maintain team and vendor budgets within approved amounts.
What youll bring:
- Bachelors degree in business healthcare or systems management or related field or four 4 years of work experience (Required)
- Eight 8 years of experience managing complex projects with interrelated Systems Process and Business requirements (Required)
Preferred Qualifications:
- One 1 year supervisory experience
- Five 5 years of experience in a health plan or related field
- Experience with quality measures inclusive of HEDIS CAHPS and HOS
- Experience with provider community and market anomalies as applicable
- Experience with claims payment systems and processes
Premera total rewards
Our comprehensive total rewards package provides support resources and opportunities to help employees thrive and grow. Our total rewards are more than a collection of perks theyre a reflection of our commitment to your health and wellbeing. We offer a broad array of rewards including physical financial emotional and community benefits including:
Medical vision and dental coverage with low employee premiums.
Voluntary benefit offerings including pet insurance for paw parents.
Life and disability insurance.
Retirement programs including a 401K employer match and believe it or not a pension plan that is vested after 3 years of service.
Wellness incentives with a wide range of mental wellbeing resources for you and your dependents including counseling services stress management programs and mindfulness programs just to name a few.
Generous paid time off to reenergize.
Looking for continuing education We have tuition assistance for both undergraduate and graduate degrees.
Employee recognition program to celebrate anniversaries team accomplishments and more.
For our hybrid employees our oncampus model provides flexibility to create your own routine with access to onsite resources networking opportunities and team engagement.
Commuter perks make your trip to work less impactful on the environment and your wallet.
Free convenient onsite parking.
Subsidized oncampus cafes make lunchtime connections with colleagues fun and affordable.
Engaging onsite events and activities include food trucks health and wellness DEI and disaster preparedness fairs coffee connects and more.
Our complementary fitness & wellbeing center offers both inperson and virtual workouts and nutritional counseling.
Need a brain break Challenge someone to a game of shuffleboard or ping pong while on campus.
Equal employment opportunity/affirmative action:
Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race color religion sex national origin age disability marital status veteran status gender or gender identity sexual orientation genetic information or any other protected characteristic under applicable law.
If you need an accommodation to apply online for positions at Premera please contact Premera Human Resources via email at or via phone at.
The pay for this role will vary based on a range of factors including but not limited to a candidates geographic location market conditions and specific skills and experience.
The salary range for this role is posted below; we generally target up to and around the midpoint of the range.
National Plus Salary Range:
$109000.00 $185300.00*National Plus salary range is used in higher cost of labor markets including Western Washington and Alaska.
Were happy to discuss compensation further during the interview because we believe that open communication leads to better outcomes for all. Were committed to creating a diverse and inclusive environment where all employees are celebrated for their unique skills and contributions.
Required Experience:
Manager
Employment Type
Full-Time
