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Manager Hcc Risk Adjustment Jobs in Michigan (NOW HIRING)

DataAnnotation

Risk Adjustment Analyst

Lansing, MI · Remote

$20/hr

We are looking for a Risk Adjustment Analyst to join our team to train AI models. You will measure ... Cycle Management & Patient Finance, Pharmacy Operations (Pharm Tech), Laboratory Services and ...

MyMichigan Health

HCC Coder

Midland, MI · On-site

$16 - $21.50/hr

Travel to provider office location/offices for HCC education as determined by manager * Mandatory ... Risk Adjustment Factor (RAF) scores (25%) Understands risk adjusted payment methodologies, HCC ...

Kanak Elite Services Inc

Sr. Business Analyst

Grand Rapids, MI · On-site

$88.80K - $114.80K/yr

Risk Management * They develop and implement risk assessment and monitoring review processes to mitigate and/or remediate risk within the risk adjustment space. * They track and manage corrective ...

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Manager Hcc Risk Adjustment information

What are the key skills and qualifications needed to thrive as a Manager HCC Risk Adjustment, and why are they important?

To thrive as a Manager HCC Risk Adjustment, you need expertise in healthcare coding (especially ICD-10), risk adjustment methodologies, and a background in health administration or a related field, often supported by a relevant degree and coding certifications like CRC or CPC. Familiarity with risk adjustment analytics platforms, EHR systems, and healthcare data reporting tools is important. Strong leadership, analytical thinking, and effective communication skills enable you to guide teams and collaborate across departments. These skills and qualifications are essential to ensure accurate risk scoring, regulatory compliance, and optimal reimbursement for healthcare organizations.

How does a Manager HCC Risk Adjustment typically collaborate with other departments to ensure accurate risk scoring?

A Manager HCC Risk Adjustment frequently partners with coding teams, clinical staff, and data analysts to ensure that documentation and coding accurately reflect patient conditions for risk adjustment purposes. This collaboration often involves leading training sessions, reviewing charts for compliance, and coordinating audits to identify documentation gaps. Working closely with these departments helps ensure data integrity, optimize risk scores, and support organizational goals related to reimbursement and quality reporting.

What are Manager HCC Risk Adjustment jobs?

Manager HCC Risk Adjustment jobs involve overseeing teams and processes that assess and improve Hierarchical Condition Category (HCC) coding and risk adjustment in healthcare organizations. These managers ensure accurate documentation and coding of patient diagnoses to optimize reimbursement and compliance with government regulations. They collaborate with coders, clinicians, and data analysts to monitor performance, provide training, and implement best practices. Their role is critical in maximizing risk-adjusted revenue while maintaining high standards of patient data integrity.

What is the difference between Manager Hcc Risk Adjustment vs Hcc Risk Adjustment Specialist?

AspectManager Hcc Risk AdjustmentHcc Risk Adjustment Specialist
CredentialsTypically requires a bachelor’s degree, industry certifications (e.g., CPC, CCS), and experience in healthcare or risk adjustmentOften requires similar certifications and experience but may have less managerial responsibility
Work EnvironmentSupervises teams, manages projects, and collaborates with multiple departmentsFocuses on data analysis, coding, and risk adjustment tasks, often working independently or in small teams
Employer & Industry UsageCommonly employed by health plans, healthcare providers, and risk adjustment vendorsFound within similar organizations, often as a specialized role supporting risk adjustment processes

The main difference is that the Manager Hcc Risk Adjustment oversees teams and manages projects, while the Hcc Risk Adjustment Specialist focuses on technical tasks like data analysis and coding. Both roles require relevant certifications and industry experience, but the manager role involves leadership responsibilities.

What are popular job titles related to Manager Hcc Risk Adjustment jobs in Michigan? For Manager Hcc Risk Adjustment jobs in Michigan, the most frequently searched job titles are:
What job categories do people searching Manager Hcc Risk Adjustment jobs in Michigan look for? The top searched job categories for Manager Hcc Risk Adjustment jobs in Michigan are:
What cities in Michigan are hiring for Manager Hcc Risk Adjustment jobs? Cities in Michigan with the most Manager Hcc Risk Adjustment job openings:
Manager Hcc Risk Adjustment jobs near you

Risk Adjustment Informatics Specialist/Full Time/Hybrid

Corporate Services

Troy, MI

Other

Posted 10 days ago

Job description

GENERAL SUMMARY: 

Reporting to the Manager, Risk Adjustment and Value Based Payment, the Risk Adjustment Informatics Specialist has an important role in a high-profile group tasked with implementing system-wide improvements and new operational processes to ensure optimal and compliant participation in Risk Adjustment, HCC Coding, and other value based reimbursement models. Is responsible for complex program analytics and process improvement activities and acts with a high degree of autonomy focusing on Risk Adjustment, HCC Coding, and other Value Based Reimbursement programs. Collaborates with internal teams to develop and maintain program dashboards and report on all Risk Adjustment and HCC coding activities and proactively identify areas for improvement. Serves as a subject matter expert in all areas of Risk Adjustment methodologies and HCC coding and provide expertise to all areas across the health system. Maintains thorough knowledge of CMS and other program requirement updates and communicate changes to key technical and operational leaders to ensure continued compliance and optimal performance. This position requires strong interpersonal and communication skills and well-developed analytic and organizational skills. Develops and implements a comprehensive program to collect data and effectively report information from data to a variety of customers including conducting complex statistical analysis and developing new approaches to measurement and analysis. The customers and end users of this support service include physicians, other clinical service and hospital leaders, Revenue Cycle leadership, physician groups, the Board of Trustees, System leadership, and external oversight/regulatory bodies. This position generates reports and supports comparative data base assessment and maintenance regarding strategic and operational performance for performance review, operational effectiveness, and improvement efforts. The Risk Adjustment Informatics Specialist is a highly analytical thinker with talent for scrutinizing diverse data sources to identify areas of improvement in Risk Adjustment and HCC Coding

EDUCATION/EXPERIENCE REQUIRED: 

Bachelor's degree with a health care, science or business focus and strong technical computer knowledge or a bachelor's degree in computer science with strong health care experience required. 

Master's degree or equivalent experience in health care, science, business, engineering, or computer science preferred. Five (5) years of experience in a healthcare or business setting required. 

Seven (7) years of experience in a healthcare or business setting preferred. 

Quantitative analysis experience in data science capabilities including data mining, predictive modeling, machine learning, statistical modeling, large scale data acquisition, transformation, and structured and unstructured data analysis. 

Extensive experience in Risk Adjustment methodologies, Risk Adjustment Factor Score calculation, governmental programs, and HCC coding. 

Knowledge of and access to relevant System data or data gathering techniques. 

Expert in the use of Microsoft Office products, particularly Excel, but also Access, PowerPoint, Word, Project, PowerBI. 

Extensive knowledge of Medicare, Medicaid, Blue Cross and other third-party payers billing and reimbursement regulations/policies, particularly around Risk Adjustment, HCC Coding, and other value-based reimbursement programs. 

Experience in gathering and organizing data and information from disparate sources and presenting findings to leadership in a way that is useful for decision support, benchmarking, and quality performance tracking. 

Excellent oral and written communication skills, including the ability to teach complex technical/analytical concepts to System leadership, management, and staff. 

Comfortable communicating complex ideas and strategic recommendations to clinicians and executive leadership. 

Strong interpersonal skills; ability to communicate effectively with all levels of management and staff across the System. 

Project management and/or LEAN, Six Sigma experience a plus.

Additional Information
  • Organization: Corporate Services
  • Department: HCC Administration
  • Shift: Day Job
  • Union Code: Not Applicable

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