Manager, Actuary

Your Role

 

 

The Risk Adjustment team is hiring a Manager of Risk Adjustment Retrospective Analytics. The Manager, Actuary will report to the Vice President of Risk Adjustment. In this role you will have end-to-end oversight of the Medicare Chart, ACA Chart, and RADV data analytics which will involve leading a team of analysts to support chart chase creation for medical records retrieval and coding of retrieved charts and ensure complete and accurate supplemental submission. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Work

 

 

In this role, you will:

• Have overall responsibility and accountability for reviewing staff work product related to reserving, CMS/ACA related risk adjustment processes, pricing, forecasting, trend setting, and/or network development and alternative provider payment models
• Be responsible for developing and managing experience tracking reports, comparisons to plan, tracking and quantifying variances and shares insights with the business unit and management 
• Ensure team follows existing workflow procedures or policies and/or validate or develop new procedures and policies
• Be responsible for understanding current and emerging regulatory and competitive developments, facilitating communication of these developments, and ensuring processes and procedures are consistent with changing regulations
• Lead special projects/ committees/task forces

• Lead a team of 7 analysts to ensure encounter data being sent to CMS is complete and accurate. This oversight is done through reviewing 500K+ medical encounters for chart chase (through a chart retrieval/coding vendor), and ensuring the supplemental data is consistent with the medical record

• Program oversight including program updates, financial monitoring, budget tracking, competitor benchmarking, regulation monitoring and compliance, program management including chase list generation and validation, retrieval management, coding management, data submission, final sign-off, vendor oversight management and contracting, maintenance of up-to-date process documentation

• Quality assurance oversight of vendor coding accuracy in partnership with Risk Adjustment Coding manager

Your Knowledge and Experience
 

• Requires a bachelor’s degree in actuarial science, mathematics, statistics, computer science or equivalent experience

• Requires at least 7 years prior relevant job experience including 3 years of experience operating in a team leader role

• Requires an ASA designation or has the majority of the courses completed to receive an ASA designation

• Requires 2 years of prior experience managing ACA Chart, MA Chart, ACA RADV, MA RADV, or similar Risk Adjustment retrospective program, or significant evidence of major prior financial or analytical experience and significant evidence of major project management skills.

• Requires strong ability to communicate complex technical subjects to non-technical audiences.

• Requires strong project and team management skills.

• Requires problem-solving skills, self-motivation, detail orientation and critical thinking skills