• Risk Adjustment Manager

    Job Locations US-CA-Aliso Viejo
    Req No.
    Business Development
    Regular Full-Time
  • Overview


    ConcertoHealth Inc. is the leading provider of specialized primary care and supporting clinical services for complex, frail, elderly, and dual-eligible patients. Operating exclusively in value-based agreements, ConcertoHealth provides high-touch, individualized care for patients, and deploys wraparound clinical resources to extend the reach of primary care practices. This comprehensive medical management solution, elevated by Concerto’s proprietary population health technology, improves overall healthcare quality and patient outcomes, benefitting payers and their provider networks.


    Concerto delivers comprehensive care to Medicare, Medicaid, and complex-needs patients. The Concerto name reflects our unique approach to healthcare. It’s about how we work in concert with patients, providers, and health plans. Our approach focuses on bringing harmony across the spectrum of a patient’s care, health, and dignity.


    The company is headquartered in Aliso Viejo, Ca. For more information, please visit: www.concertohealth.com


    The Manager, Clinical Documentation Strategy and Operations will lead the production and analysis of risk adjustment and financial data associated with all aspects of Risk Adjustment and Quality programs as well as enterprise-wide operational process improvement related to risk adjustment and financial analytics.


    The manager will also serve as the lead in efforts to work with health plan partners and vendors in the analysis of risk adjustment and financial data and will work to develop and implement processes to more efficiently and effectively exchange data, monitor data receipt and submission, and rectify data issues and discrepancies.


    The manager will also lead internal efforts to develop robust reporting capabilities associated with the financial aspects of risk adjustment and quality programs. In addition, the manager will ensure that all departments (e.g. Quality & Clinical Documentation, Corporate Development, Finance, and IT) have the reports and data necessary to effectively monitor and report on risk adjustment and quality activities for current, potential, and future payer partners.


    The manager will lead cross-functional and inter-departmental efforts and initiatives to facilitate the understanding of risk adjustment analytics and financial reporting and help drive, through collaboration with management and staff, enterprise-wide performance improvement.


    The candidate will bring extensive experience with financial and risk adjustment reporting and analytics and a strong healthcare finance background. The candidate will also bring deep expertise in SQL and advanced Microsoft Excel analytics and reporting.




    • Provides technical expertise in analytics and reporting related to risk adjustment and other financial reporting
    • Manages the analysis of risk adjustment data and statistics and facilitates the reporting of results to ConcertoHealth leadership and external partner management
    • Leads efforts, in collaboration with corporate departmental leadership, to drive implementation and operationalization of sophisticated solutions in support of risk adjustment programs and reporting efforts
    • Serves as the lead for management of Risk Adjustment analytics with health plan partners and vendors
    • Serves as the lead liaison to the finance department for analytics and reporting related to the financial aspects of Risk Adjustment and Quality programs
    • Manages the development of reporting and data tracking in coordination with IT, finance, and vendor partners to ensure proper, complete, and accurate exchange and analysis of data
    • Leads efforts to resolve data integrity and other reporting issues
    • Provides generation and analysis of financial and operational data by department, service line, and market
    • Develops detailed reports, scorecards, and dashboards with KPIs/metrics to measure and monitor the business
    • Completes other projects and tasks as assigned



    Required Qualifications:

    • Undergraduate degree or equivalent experience
    • 5+ years of healthcare finance experience with managed care or provider group preferred
    • 5+ years of SQL experience including advanced capabilities in query development, relational databases and procedure execution along with advanced data analytics and reporting experience
    • 5+ years of healthcare industry experience
    • Expertise in Medicare Risk Adjustment analytics and reporting
    • Knowledge of the Medicare, Medicaid, and Medicare Advantage healthcare plans
    • Advanced proficiency with MS Excel, Word, and PowerPoint
    • Strong written and verbal communication skills
    • Demonstrated ability to communicate ideas clearly and concisely
    • Excellent time management, organizational, and prioritization skills and ability to balance multiple priorities


    Preferred Qualifications:

    • MBA, MHA, or other relevant degree
    • Understanding of Health Plan, Provider Group, and Clinic Operations
    • Experience working in Healthcare Settings/with Clinicians
    • Experience working with IT and database technologies


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