Director of Revenue and Risk Management

Risk Management Park Ridge, Illinois


Description

Position at Clear Spring Health

Group1001 is a consumer-centric, technology-driven family of insurance companies on a mission to deliver outstanding value and operational performance by combining financial strength and stability with deep insurance expertise and a can-do culture. Group1001’s culture emphasizes the importance of collaboration, communication, core business focus, risk management, and striving for outcomes. This goal extends to how we hire and onboard our most valuable assets, employees.

Director of Revenue and Risk Management

Location – Park Ridge, IL

Company Overview:

Clear Spring Health is part of Group One Thousand One (“Group1001”), a customer-centric insurance group whose mission is to make insurance more useful, intuitive and accessible so that everyone feels empowered to achieve financial security. Clear Spring Health is dedicated to helping seniors protect their health and well-being by providing Medicare Advantage plans in select counties of Colorado, Illinois, North Carolina, and Virginia, plus Georgia and South Carolina through our affiliate, Eon Health (redirects to Eon). In addition, Clear Spring Health sponsors Medicare Prescription Drug plans in 42 states.  

Job Summary:

The Director of Revenue and Risk Management is responsible for all aspects of risk adjustment within the Medicare Advantage organization and plays a critical role in the development and execution of business strategy and compliance. This leader is responsible for implementing strategic plans and managing day-to-day health plan risk adjustments and data analysis.

Main Accountabilities:

  • Oversee and manage the schedule of Risk Adjustment functions
  • Preforms data analysis to accurately report program performance
  • Assists with the development of monthly revenue accruals related to the risk adjustment activities and participate in annual budget process
  • Monitors staff compliance regarding departmental policies and procedures
  • Demonstrates expert knowledge of CMS best practices including Medicare Advantage models

Qualifications:

  • Bachelor’s degree or equivalent relevant experience or a requirement?
  • 5+ years of experience in Medicare Advantage Risk management preferred
  • 3+ years of Risk Adjustment Data Validation (RADV) process/audit experience
  • Knowledge of CPT and ICD-10 coding SAS programming skills SQL programming skills
  • Strong interpersonal skills and ability to work with all levels in an organization.
  • Advanced presentation skills needed.
  • Proficiency with Microsoft Office