Edifecs Careers

Principal Risk Adjustment Program Manager
 

Overview

We are seeking a passionate and experienced Principal Risk Adjustment Program Manager to join our team and play a crucial role in ensuring our customers achieve long-term success with Edifecs products.

The ideal candidate will leverage their operational knowledge on processing data through various systems, recognizing revenue and audit regulations, and technical expertise in all risk adjustment areas to guide customers towards maximizing their business value and maximizing Edifecs' footprint in the healthcare payer and risk-bearing provider space.

What you will do:

• Develop, implement, and enforce best practice guidelines, templates, and workflows for risk adjustment application customers.
• Support implementation at a customer level through advising and troubleshooting elements that arise related to customer’s best use of software and services.
• Lead customers to success from the beginning of their experience by understanding their business needs and proactively aligning Edifecs' software and services with those needs to generate outstanding results.
• Partner with Sales, Account and Product Management on solutioning, contracting, and implementing customers to stage for long-term success.
• Utilize your operational knowledge to recognize compliance and audit regulations to ensure accurate and compliant business practices.
• Leverage your technical expertise in all risk adjustment areas to provide valuable insights and support to customers in this critical area.
• Responsible for communicating customer enhancement requests via a feedback loop to the Product Management team.
• Ensure all contracted deliverables are provided according to the contract, on time, and meet and exceed customer expectations.

What you will bring:

• Bachelor's degree with 10+ years direct experience in managing risk adjustment operations with a payer or risk-bearing provider
• Operational knowledge on processing data through various systems, recognizing revenue and audit regulations, and technical expertise in all risk adjustment areas - Various levels of experience in the payer or risk-bearing provider space
• Fluent in Software as a Service (SaaS) distribution models
• Experience in healthcare or related field
• Solid organizational skills, including attention to detail and multi-tasking abilities
• Strong working knowledge of Microsoft Office, Freshdesk, and Jira

Note: The expected base pay range for this position is $159,146 - $200,000 per year. Base pay offered may vary depending on location, job-related knowledge, education, and experience.     

We are pleased to offer our associates a comprehensive well-being plan.  Our offerings include medical, dental, vision, life, and disability insurance, a 401(k) retirement savings plan including an Edifecs matching contribution, and up to 25 days of PTO and 10 holidays per year.  More information on these and additional well-being offerings can be found here.

About Edifecs

Edifecs is a premier technology company serving the U.S. healthcare market that empowers its customers to transform healthcare. For over 25 years, Edifecs has provided the market-leading interoperability platform. Edifecs payer and provider customers and technology partners are driving healthcare transformation with the ability to seamlessly exchange, unify, and normalize data to derive insights and intelligence and replace friction with collaboration across all stakeholders. Edifecs’ platform is the foundation to help customers overcome healthcare’s biggest challenges, including accelerating the adoption of value-based payment models, securing complete and accurate care funding for alternative payment models, and fully automating prior authorization. Edifecs offers natural language processing, machine learning, and artificial intelligence to provide deeper insights into patients, populations, and business processes. As new standards and regulations continually emerge in government agencies, Edifecs is a proven partner to ensure its customers maintain “evergreen” compliance. Edifecs customers cover 290 million lives and include 100% of national health plans, 70% of state Medicaid programs, and 94% of the lives covered by Blue Cross Blue Shield payers.
 

We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity, religion, national origin, disability, veteran status, age, marital status, pregnancy, genetic information, or other legally protected status.
 

Edifecs will provide reasonable accommodation to individuals with disabilities who need assistance applying for a job.  Please contact [email protected] for more information.