Sr. Manager, Risk Adjustment & Quality
On-site · Doral, Florida, United States
Job Summary
Centrum Health’s Sr. Manager of Risk Adjustment and Quality will lead the risk adjustment, coding, billing operations, and quality initiatives for owned clinics and affiliated practices. The role manages a team of Risk Adjustment Coders, HEDIS specialists, Billers, and Auditors, collaborates across Physicians, Clinical Operations, Data/Technology, and Finance, and ensures regulatory compliance while driving performance across Medicare Advantage, ACO, Medicaid, and ACA lines of business. Responsibilities include program management for retrospective and prospective encounter facilitation, data submission, and supporting in-office and virtual engagements; develop analytics-driven gap-closure programs; collaborate with Actuarial and Analytics teams to design strategies, and oversee RADV audits. Occasional travel is required and bilingual Spanish/English communication is necessary.
Required Qualifications
- Bachelor’s degree in a healthcare-related field or equivalent experience
- Six (6) or more years of experience in healthcare Risk Adjustment
- Three (3) or more years of leadership experience
- CPC, CRC, and CPMA certifications are highly preferred
- Bilingual in Spanish and English required
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