Description

: 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 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 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