Risk Adjustment Manager - Mid-Atlantic Permanente Medical Group PC

Mid-Atlantic Permanente Medical Group (MAPMG) invites applications for a Risk Adjustment Manager to join our Operational Finance department. This position is a full-time based out of our regional office located in Rockville, Maryland with a hybrid work model.

Mid-Atlantic Permanente Medical Group is comprised of more than 1,700 Permanente physicians and nearly 300 staff professionals who come together to make a positive impact on the health and lives of more than 800,000 members in Virginia, Maryland, and the District of Columbia.

Reporting to a Director of Operational Analytics, the Risk Adjustment Manager oversees risk adjustment operations and outcomes across the organization's assigned products, focusing on identifying areas for improvement and implementing effective processes. You will also support internal Risk Adjustment Data Validation (RADV) monitoring programs and audits, interpret statistical analyses to enhance quality and population health, and collaborate with provider leadership to maintain and enhance risk adjustment accuracy.

You can expect to:

•  Oversee the outcomes and operations of risk adjustment across the organization within all the assigned products and identifies areas of improvements and implements processes as needed
•  Interpret statistical analyses and helps stakeholders derive meaning from them to improve quality, risk adjustment and overall population health
•  Conduct a wide range of analytical frameworks, quantitative, qualitative, and mixed methods analysis to answer questions to improve quality, stars and risk adjusted outcomes.
•  Generates reports of findings, recommendations and alternatives and delivers formal presentations of analytic findings and recommended action steps to management and senior leaders.
•  Analyze multiple data sets to create reports and data presentations, and creates dashboards, for leadership and managerial use

What is required:

• Bachelor’s degree in business in business, healthcare administration, or related field is required
• Minimum of six (6) years of healthcare data analytics experience is required; Experience with a provider organization is strongly preferred.
• Minimum of two (2) years of experience in a supervisory or management position is required
• Experienced in handling and manipulating large-scale datasets using tools like Access, SQL, SAS, and others, particularly within multi-system environments is required
• Extensive Knowledge of Medicare Advantage and/or Affordable Care Act rules and regulations, preferably with experience related to Risk Adjustment policies and best practices, and ICD-10-CM/outpatient and CPT coding principles and guidelines
• Knowledge of Risk Adjustment Payment methodologies and understanding of the CMS HCC, HHS, and Medicaid
• Demonstrated competency in resource and project management: organizing work, providing leadership to staff, establishing measures for success, and managing to deliverables
• Adept at clear and concise communication, both orally and in writing, across all organizational hierarchies
• Ability to commute to Rockville, MD, on an as-needed basis is required
• Candidates must either currently live in or be willing to relocate to the Washington D.C., Maryland, or Virginia area
• Must provide proof of Covid booster vaccine (released in September 2023) and influenza vaccine as a condition of employment

Competitive Benefits:

• Competitive compensation package
• 100% employer-funded medical and dental insurance premiums for employees and families effective on the first day of employment
• Generous paid time off, including vacation, holidays, and sick leave, plus maternity and parental leave
• Pension plan, and 401(k) retirement plan with employer contributions
• Life insurance, short-term disability, and long-term disability coverage
• Education reimbursement

Equity, Inclusion, and Diversity: 

MAPMG continuously works to identify and mitigate healthcare inequities, and that starts with providing an inclusive, supportive environment for our physicians and staff. We encourage applicants of any race, color, religion, sex, sexual orientation, gender identity, or national origin who value diversity and will commit to practicing culturally competent healthcare.

External hires must pass a background check and drug screening.

We are proud to be an equal opportunity/affirmative action employer.

We value our diversity and E/O/E M/F/D/V.