Risk Adjustment Outreach Manager
Hispanic Alliance for Career Enhancement, Phila, PA, United States
We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Job description
Under the direction of the Senior Manager of the RI Retro Ops Team, the
Risk Adjustment Outreach Manager
is responsible for leading initiatives that support the organization’s risk adjustment program and ensure timely and accurate data capture.
A Brief Overview
In this role, you will manage large‑scale projects, analyze performance data, and collaborate with key stakeholders. You will build vendor relationships and engage providers to drive successful chart retrieval efforts and achieve organizational goals.
This is a remote position within the continental US.
What you will do
Project Leadership:
Manage assigned territory within the risk adjustment program from planning through completion, including leading cross‑functional meetings, setting timelines, and tracking progress.
Chart Retrieval Oversight:
Ensure timely and accurate chart retrieval by managing processes, resolving barriers, and maintaining compliance.
Provider Engagement:
Conduct outreach to providers to address retrieval challenges and negotiate fees when necessary.
Data Retrieval & Entry:
Extract data from vendor portals and update designated spreadsheets, ensuring accuracy and timeliness.
Vendor Management:
Build and maintain vendor relationships, monitor performance and risks.
Data Analysis & Reporting:
Analyze data to identify trends, and develop actionable insights for program optimization. Present findings to senior leadership and external stakeholders.
Performance Monitoring:
Track and report on key metrics to ensure retrieval targets and internal benchmarks are consistently achieved.
Cross‑Functional Collaboration:
Partner with Market/Network teams and Provider Relations to align initiatives with organizational objectives.
Minimum Requirements
5-7 years of professional experience, preferably in healthcare operations, risk adjustment, or related fields.
Advanced proficiency in Microsoft Excel (pivot tables, VLOOKUP, data analysis, reporting).
Strong analytical, problem‑solving, and project management skills.
Ability to work independently and manage priorities with minimal supervision.
Excellent verbal and written communication skills.
Proven ability to build relationships and collaborate across teams.
Experience managing complex territories and cross‑functional projects.
Preferred Qualifications
Experience in risk adjustment, vendor management, and program management.
Familiarity with systems and tools used for chart retrieval and retrospective operations.
Negotiation skills and experience resolving provider participation barriers.
Education
Bachelor's degree or an equivalent combination of education and experience will be considered.
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
$54,300.00 - $145,860.00
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
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Job description
Under the direction of the Senior Manager of the RI Retro Ops Team, the
Risk Adjustment Outreach Manager
is responsible for leading initiatives that support the organization’s risk adjustment program and ensure timely and accurate data capture.
A Brief Overview
In this role, you will manage large‑scale projects, analyze performance data, and collaborate with key stakeholders. You will build vendor relationships and engage providers to drive successful chart retrieval efforts and achieve organizational goals.
This is a remote position within the continental US.
What you will do
Project Leadership:
Manage assigned territory within the risk adjustment program from planning through completion, including leading cross‑functional meetings, setting timelines, and tracking progress.
Chart Retrieval Oversight:
Ensure timely and accurate chart retrieval by managing processes, resolving barriers, and maintaining compliance.
Provider Engagement:
Conduct outreach to providers to address retrieval challenges and negotiate fees when necessary.
Data Retrieval & Entry:
Extract data from vendor portals and update designated spreadsheets, ensuring accuracy and timeliness.
Vendor Management:
Build and maintain vendor relationships, monitor performance and risks.
Data Analysis & Reporting:
Analyze data to identify trends, and develop actionable insights for program optimization. Present findings to senior leadership and external stakeholders.
Performance Monitoring:
Track and report on key metrics to ensure retrieval targets and internal benchmarks are consistently achieved.
Cross‑Functional Collaboration:
Partner with Market/Network teams and Provider Relations to align initiatives with organizational objectives.
Minimum Requirements
5-7 years of professional experience, preferably in healthcare operations, risk adjustment, or related fields.
Advanced proficiency in Microsoft Excel (pivot tables, VLOOKUP, data analysis, reporting).
Strong analytical, problem‑solving, and project management skills.
Ability to work independently and manage priorities with minimal supervision.
Excellent verbal and written communication skills.
Proven ability to build relationships and collaborate across teams.
Experience managing complex territories and cross‑functional projects.
Preferred Qualifications
Experience in risk adjustment, vendor management, and program management.
Familiarity with systems and tools used for chart retrieval and retrospective operations.
Negotiation skills and experience resolving provider participation barriers.
Education
Bachelor's degree or an equivalent combination of education and experience will be considered.
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
$54,300.00 - $145,860.00
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
#J-18808-Ljbffr