Overview
Supplier Quality Engineering and Inspection Specialist Jobs in Grants Pass, OR at Vendor Control Service, Inc.
Job Summary:
The Senior Manager, Quality Risk Adjustment Programs is responsible for driving execution of the Quality Risk Adjustment (QRA) programs and managing the development of and adherence to the QRA Compliance Plan across all lines of business for the organization.
Essential Functions:
This position serves as the source of truth for Risk Adjustment coding guidelines and is accountable for project managing all audits including but not limited to Risk Adjustment Data Validation (RADV)
Builds and manages Quality Risk Adjustment Team to perform risk adjustment auditing in a virtual environment
Works with all markets to develop and execute new, scalable, consistent provider education programs including onsite sessions, webinars, developing compliant leave-behinds, and more
Uses analytics to identify potential risk adjustment compliance risks
Trends data and prepares corrective action plans to remediate issues and to mitigate future risks
Develops QRA program dashboards, vendor QA reports, and productivity reporting using KPIs
Analyzes provider/member data to ensure the Risk Adjustment Factor accurately reflects the membership health profile
Project manages the Risk Adjustment Department’s policies and procedures processes with input from stakeholders – ensures deadlines are met with necessary revisions
Develops and implements processes and procedures to ensure the accuracy and completeness of the Medicare Risk Adjustment, Medicaid and ACA/Marketplace data, and to ensure compliance with all CMS and State regulations and guidelines
Maintains understanding of all CMS and state requirements and directives for Risk Adjustment to ensure process is compliant with these requirements
Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions including employment, termination, performance reviews, salary reviews, and disciplinary actions.
Works closely with CareSource’s Legal and Compliance teams to identify risks and to build strategy to mitigate them including but not limited to managing the QRA team, providing feedback to vendors and providers, and developing a scalable, consistent provider education program
Requires the use of strong project management skills using Key Performance Indicators (KPIs) to drive operational execution of the QRA Team including tracking and managing productivity of QA work and provider education
Responsible for developing, implementing, and managing CareSource’s Quality Risk Adjustment Provider Education program at a market level to help improve risk adjustment accuracy
Uses data analytics for identification of provider level risk opportunity, assignment of provider intervention approaches, working closely with market leadership to engage/educate providers
Perform any other job duties as requested
Education and Experience:
Bachelor of Science degree in Finance, Business Administration, or Clinical related field or equivalent work experience is required
Seven (7) years of experience in healthcare, preferably in a managed care organization
Three (3) years of risk adjustment coding/auditing experience
Three (3) years of people management, overseeing medical chart coding/auditing teams
Experience managing complex projects in a virtual and in-person environment
Competencies, Knowledge and Skills:
Proficient with Microsoft Excel
Knowledgeable of CDPS-Rx and HHS/CMS Risk Adjustment regulations
Knowledgeable of ICD-10 and CPT codes
Knowledge of healthcare reporting standards preferred
Ability to manage, develop, motivate and reward professional staff
Ability to effectively report data, analyze facts, and exercise sound business judgment when making recommendations
Critical listening and thinking skills
Proficient with Microsoft Suite to include Word, Power Point, Outlook, Visio, and MS Project
Ability to work independently and to manage multiple priorities with limited resources
Ability to analyze problems, draw conclusions, develop processes and communicate status and results
Excellent oral and written communication skills
Ability to interact with executive levels of management as well as external stakeholders
Licensure and Certification:
Certified in medical coding: American Association of Professional Coders (AAPC) or American Health Information Management Association (AHIMA) required
Project Management Professional (PMP) strongly preferred
Working Conditions:
General office environment; may be required to sit or stand for extended periods of time
Compensation Range:
$110,800.00 – $193,800.00
CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Salary
Organization Level Competencies
Create an Inclusive Environment
Cultivate Partnerships
Develop Self and Others
Drive Execution
Influence Others
Pursue Personal Excellence
Understand the Business
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.
Title: Supplier Quality Engineering and Inspection Specialist
Company: Vendor Control Service, Inc.
Location: Grants Pass, OR
