Risk Adjustment Coordinator (5702BR) Columbus, Ohio

Job Summary

 Responsible for implementing and monitoring local risk adjustment coordination efforts.

Essential Functions

• Defines and implements HP risk adjustment strategy in conjunction with Corporate Risk Adjustment department and plan QI and Provider Services Directors
• Works with Manager, Coding and Education and Manager, Vendor Oversight and CMS Submission to implement appropriate chart reviews and in-home assessments
• Removes barriers to access to provider records and / or barriers to contacting members
• Works with HP and Corp Reporting to monitor completed provider and member assessments to ensure Corporate goals are achieved within that HP
• Escalates problems promptly that would prevent Corporate goals from being achieved and recognizes the financial and compliance risk of not doing so
• May be asked to Upload HEDIS & RAMP files as directed by HEDIS & Risk Manager to File Net storage solution in a timely manner
• May be asked to Monitor and bring resolution to data mismatch and errors within FileNet
• Assists in current load of  files as well as historical upload to FileNet

Knowledge/Skills/Abilities

 



Required Education:
Bachelor's degree or equivalent work experience
Required Experience:
• Minimum of 1 year experience in health plan quality improvement or equivalent experience
Required Licensure/Certification/Associations:
 
Preferred Education:
Preferred field: clinical, public health or healthcare
Preferred Experience:

Preferred Licensure/Certification/Associations:
Some clinical training (ie LVN, EMT, LCSW, Medical Assistant)



To all current Molina employees if you are interested in applying for this position please apply through the intranet job listing. Also, fill out an Employee Transfer Request Form (ETR) and attach it to your profile when applying online.

Molina Healthcare offers competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

To apply, please click here