Office based in Woodland Hills, CA or Santa Ana, CA
Represent Aetna to our contracted providers and focus on executing on national initiatives at local market level through identifying local market Risk Adjustment opportunities to improve accuracy and completeness of captured codes.
Manage and direct local and national vendors around provider and member outreach and engagement.
Conduct data analysis, in conjunction with national tools, to identify opportunity areas and present to key stakeholders.
Provides feedback to providers on accuracy and improvement opportunities relevant to Risk adjustment.
Develops training documents and tools; assures that internal and external stakeholders related to CMS guidelines and Risk
Adjustment best practices.
Engage with clinical team and specific clinics, medical groups, hospitals; attends JOM meetings; Supports and interact with quality engagement managers and RN program managers as needed.
Additional dock-in points needed to manage include MSO, product, sales, network, performance, MEU.
Integrates risk adjustment activities with quality initiatives where possible.
Identifies alternate data sources and facilitates capture through corporate processes