Director of Risk Adjustment Management - New Orleans, LA

Careers at UnitedHealth Group

We're creating opportunities in every corner of the health care marketplace to improve lives while we're building careers. At UnitedHealth Group, we support you with the latest tools, advanced training and the combined strength of high caliber co-workers who share your passion, your energy and your commitment to quality. Join us and start doing your life's best work. SM


Compassion. It's the starting point for health care providers like you and it's what drives us every day as we put our exceptional skills together with a real feeling of caring for others. This is a place where your impact goes beyond providing care one patient at a time. Because here, every day, you're also providing leadership and contributing in ways that can affect millions for years to come. Ready for a new path? Learn more, and start doing your life's best work. SM

Our teams are helping people from around the world. We can bring out your best as you put your listening, analytical and problem solving skills to work in a setting that is geared to helping improve lives and enhance health care for millions. Here, you'll discover a wealth of pathways for professional growth within Customer Service, Billing, Claims, Enrollment & Eligibility and across our global economy. Join us and find out why this is the place to do your life's best work. SM

UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm)

Primary Responsibilities:
  • Risk Adjustment Management
    • Leads a cross-functional, multi-departmental team responsible for the collection, validation and submission of diagnosis data to the Centers for Medicare and Medicaid Services (CMS)
    • Recruits, mentors, trains, and manages the Risk Adjustment team
    • Manages revenue initiatives and work cross-functionally with clinical and technical teams to develop the tools, processes, and reporting required to ensure complete and accurate coding
    • Designs, implements, and evaluates risk score accuracy initiatives and interventions
    • Establishes standardized processes and procedures for the timely collection, submission, and validations of diagnosis data
    • Monitors the timeliness and completeness of diagnosis submissions and acceptance through Risk Adjustment Processing System (RAPS) and Encounter Data Processing System (EDPS)
    • Serves as liaison to all departments to resolve issues and concerns in the area of risk score management and revenue cycle process
    • Supports Risk Adjustment Data Validation Audits (RADV) from various regulatory agencies
  • Supervisory Responsibility
    • Oversee a team of medical coders, nurses, data analyst, and support staff to accurately collect and report Medicare risk adjustment data

Core Competencies:
  • Develops, performs, and manages analyses of business/financial metrics and performance measures
  • Balances the needs of business, segment, and enterprise constituencies
  • Ability to handle many different tasks simultaneously
  • Excellent organizational skills with great attention to detail
  • Solid communication and interpersonal skills
  • Solid financial and analytical skills
  • Develop and maintain financial reports to clearly communicate actual results, forecast performance, and variances to forecast and budget
  • Knows where to obtain relevant data to efficiently meet the reporting needs of management
  • Understands and incorporates industry specific metric into reports to support fact-based business decisions
  • Produces clear, well-formatted reports that communicate a clear compelling message
  • Works closely with the business to develop, recommend and establish strategies, plans, and processes to improve performance and efficiencies

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:
  • Undergraduate degree or equivalent (Finance or Accounting preferred)
  • 3+ years of experience in Medicare Health Plan, including 2+ years in supervisory capacity
  • Experience in healthcare finance industry plan analytics including statistical analysis, informatics, and business problem solving related to payment validation, reimbursement, payments, contracting; medical coding, clinical editing, and fee schedules
  • Experience in Medicare Risk Adjustment analytics, operations, and processes
  • Knowledge of Microsoft Office and Microsoft SQL Server
  • Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

Careers at UnitedHealthcare Medicare & Retirement. The Boomer generation is the fastest growing market segment in health care. And we are the largest business in the nation dedicated to serving their unique health and well-being needs. Up for the challenge of a lifetime? Join a team of the best and the brightest to find bold new ways to proactively improve the health and quality of life of these 9 million customers. You'll find a wealth of dynamic opportunities to grow and develop as we work together to heal and strengthen our health care system. Ready? It's time to do your life's best work.(sm)

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Job Keywords: Director, Risk Adjustment, Audit, Medicare, Medicade Audits, Excel, Finance, New Orleans, LA, Louisiana