Medical Mutual of Ohio Provider Risk Adjustment Specialist in Columbus, Ohio

Responsible for risk adjustment program implementation and provider performance management. Track and monitor provider metrics to identify coding gaps and closure opportunities. Partner with providers to build relationships; ensure effective education and reporting; and proactively identify performance improvement opportunities through analysis and discussion with subject matter experts.

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Responsibilities

  • Participates in outreach/intervention strategy development to determine best practices approach with members and providers to assist in improving risk adjustment factors and other provider performance goals

  • Develops education and incentive programs for targeted interventions based on analytics results

  • Coordinates provider risk adjustment and other provider performance activities with Provider Contracting staff and evaluates opportunities to optimize provider contract language provisions for maximizing risk scores and closing care gaps

  • Drafts/enhances internal policies and procedures to support provider risk adjustment and other provider performance programs

  • Ensures ACA and Medicare Advantage compliance

  • Educates Provider Contracting staff and other Provider Engagement personnel on risk adjustment and other provider performance programs and activities

  • Coordinates provider touch points between internal departments

  • Strong knowledge of ACA and Medicare Advantage markets

  • Bachelor’s in Business Administration, Health Care Administration or related field

· 4 years of experience in risk adjustment or general healthcare industry

  • Strong relationship building skills with clinical and non-clinical personnel

  • 1 year of risk adjustment experience preferred

  • 1 year of experience in managed care working with network and provider contracting/relations preferred

  • Strong financial analytical background with ACA and Medicare Advantage plans

  • Intermediate knowledge of Microsoft Office

We truly value and respect the talents and abilities of all of our employees. That’s why we offer an exceptional package that includes

A Great Place to Work

  • Employee discount program. Discounts at many places in and around town, just for being a Medical Mutual team member

  • Business casual attire

Excellent Benefits and Compensation

  • Competitive compensation plans

  • Employee bonus program

  • Healthcare

  • 401(k) with company match and an additional company contribution

  • Excellent medical, dental, vision, and disability insurance

An Investment in You

  • Career development programs and classes

  • Mentoring and coaching to help you advance

  • Education reimbursement up to $5K per year

About Medical Mutual

We strive to create peace of mind. Our customers can trust us to do things right and to help them get value from their health plan. For 80 years, we’ve been serving our members and the Ohio communities where they live and work.

/At Medical Mutual we celebrate differences and are mutually invested in our employees and our community. We are proud to be an Equal Employment Opportunity and Affirmative Action Employer. Qualified applicants will receive consideration for employment regardless of race, color, religion, sex, sexual orientation, gender perception or identity, national origin, age, marital status, veteran status, or disability status./

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/We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing./

Job: *7 - General Staff

Organization: *Network Development & Services

Title: Provider Risk Adjustment Specialist

Location: OH-Columbus

Requisition ID: 1700264