Mgr Risk Management Business Team
About the role
Hybrid role (3 days/week in office) at our Salt Lake City, Boise, Fargo, Portland, Vancouver, Renton, Medford, Burlington, Lewiston offices. Preference will be given to current employees and candidates who reside within a commutable distance from our Salt Lake City, Boise, Fargo and Lewiston offices or who are willing to relocate. As a member of the Risk Adjustment team, the Risk Management Business Team Manager is responsible for complying with CMS mandates to submit Enrollment, Medical Claim and Pharmacy Claim data for Reinsurance and Risk Adjustment programs. Leads a team dedicated to extracting required information from the source systems into a staging area, performing validation checks based on CMS Edge Server Business Rules, and submitting correct data to the Edge Server via a translation process – all in service of creating a person‑focused health care experience.
Responsibilities
- Corroborates closely with IT, compliance, legal, revenue management, claims, enrollment, product teams and other departments to maximize and maintain submission measurements
- Helps oversee RADV audits, submits data