Vacancy expired!
Description SHIFT: Day JobSCHEDULE: Full-timeYour Talent. Our Vision. At CareMore, a proud member of the Anthem, Inc. family of companies, it’s a powerful combination. It’s the foundation upon which we’re creating greater access to care for our members, greater value for our customers and greater health for our communities. Join us and together we will drive the future of health care. CareMore is a proven care delivery model for the highest-risk. We are a team of committed clinicians and business leaders passionate about transforming American healthcare delivery. We build and lead integrated, multi-disciplinary clinical teams to care for the most complex patients. We strive for excellence and have achieved significant and measurable improvement in total cost of care, clinical outcomes, and experience. As an Anthem subsidiary, we benefit from the scale and resources one of America’s largest managed healthcare organizations. Preferred Location:Cerritos, CAAny Anthem officeJob Summary:Responsible for designing, implementing and directing programs and initiatives related to Medicare, Medicaid and Commercial risk adjustment. Primary duties may include, but are not limited to: Designs programs, policies and procedures related to risk adjusted revenue.
Manages coding and auditing.
Communicates best practices and opportunities for improvement.
Collaborates with senior management to develop strategies and tactics that improve the accuracy of risk scores and reduce payment error risk.
Monitors established operations, tracks performance, and resolve deficits.
Accountable for the accuracy and completeness of risk scores for the health plan (includes chronic re-coding for existing members, new member coding, PAHAF completion, etc.).
Evaluates, contracts, and manages vendors.
Hires, trains, coaches, counsels, and evaluates performance of direct reports.
QualificationsRequires a BA/BS.
Minimum of 10 years health care experience with at least 5 years’ experience in Medicare risk adjustment, healthcare economics or finance.
Any combination of education and experience, which would provide an equivalent background.
Experience working with all lines of business (Medicare, Medicaid, Commercial) preferred.
Certified Professional Coder (CPC) or Certified Risk Adjustment Coder (CRC) certifications preferred.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2019 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com An Equal Opportunity Employer/Disability/VeteranREQNUMBER: PS40490
