Sr Mgr, Quality Risk Adjustment (Health plan/MCO experienced)

Job description

Job Summary: The Senior Manager, Quality Risk Adjustment is responsible for overseeing the Quality Risk Adjustment (QRA) Medical Record Review (MRR) program which includes chart retrieval and coding while ensuring compliance with regulatory standards and optimizing quality outcomes. This role will also involve leveraging artificial intelligence (AI) technologies to enhance data accuracy, improve efficiency, and overall quality in the chart review program. Essential Functions: - Lead and manage the MRR Team, providing guidance, training, and support to ensure high-quality performance in medical record retrieval and coding. - Develop and implement strategic plans to optimize risk adjustment processes and improve overall quality metrics for insourced and outsourced activities MRR. - Manage outsourced vendors to execute to operational production plan goals and contractual requirements. - Manage vendor administrative expenses including chart copying costs. - Work with QRA Compliance Team to establish and maintain MRR quality assurance protocols for medical record retrieval and coding to ensure compliance with all applicable regulations and industry standards. - Conduct regular audits an...