Full time
Highmark Health
Pittsburgh, PA, USA
Company : Highmark Inc. Job Description : JOB SUMMARY This job, is the strategic leadership role that, establishes and drives overall strategic direction, programs and services in collaboration with VP of Revenue Program Management in support of governmental products where Risk Adjustment methodologies apply. Functions as the business owner of the risk adjustment process as well as identifying and applying best practices and processes to ensure efficacy and accuracy of risk adjustment programs. Identifies and recommends both strategic and tactical improvements to these processes, and ensures compliance to all applicable laws, guidance, and regulations. Establishes metrics across RPM programs to monitor performance and drives optimal and compliant outcomes by analyzing, monitoring, forecasting and planning key risk adjustment initiatives and identifying improvement opportunities. Functions as the primary advisor of strategic direction on risk adjustment and...