Risk Adjustment Financial Manager

Description ABOUT OUR COMPANY
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.


POSITION SUMMARY
Define and implement management processes for driving best practices within functions of responsibility. Individual will manage a matrix team of different levels of skills. The Revenue Risk adjustment Manager is accountable for the effective development of leadership that supports the business units' operational plans. Participates in complex projects within the Risk Revenue Department and/or Consumer Segment and may report to lead executive on such projects..

ADDITIONAL JOB INFORMATION
As the Financial Manager in the Medicare Risk Adjustment team within the Consumer Segment, this role will be responsible to define, develop and provide information and analysis to assist with the decision-making process and support Medicare Risk Adjustment business operations for internal and external customers. This position also has a dedicated team who works in collaboration with external vendors and Aetna's Medical Care Management team to ensure the ongoing Medicare Outreach efforts run efficiently and effectively. Individual will be responsible for continuous evaluation and development of risk adjustment outreach programs, using internal systems and resources, as well as vendor solutions. Manager will recommend strategies and plans working with segment Finance on outreach forecasts for the year. Individual will also be responsible for overseeing all audit activity of the department from internal organizations, as well governmental agencies such as the Centers for Medicare and Medicaid (CMS). This position will work with the department head in yearly evaluation of strategic direction and operating model, considering changes in the Risk Adjustment space.
Additional items:

Manage internal adhoc requests for risk adjustment related data and models

Manage vendor relationships

Manage annual CMS audit/data validation

Work with Segments and Operational areas to maximize risk adjustment opportunities

Participate in CMS user group calls and regional meetings

Requirements REQUIRED SKILLS

Analyze cost and functionality of current business processes

Coach employees to maximize performance

Develop individual metrics that align to department business plans

Developing and Executing Strategy

Model business process design for cost, efficiency and customer impact

Identify critical interdependencies required to execute operating plan

8+ years managed care / health insurance industry experience

Proven track record managing projects and or programs

Project management experience

Supervisory experience

EDUCATION
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience

We value leadership, creativity and initiative.  If you share those values and a commitment to excellence and innovation, consider a career with Aetna.

How to apply
 
To learn more about this opportunity, visit us at www.aetna.com/working . Under requisition # select 28819 and submit your resume. 
 
We conduct pre-employment drug and background testing.
Aetna does not permit the use of tobacco related products or drugs in the workplace. No agencies, please.
 
Aetna is an Equal Opportunity/Affirmative Action Employer. M/F/D/V

Aetna is committed to maintaining an environment in which all employees are treated equitably and given the opportunity within the context of the business to achieve their potential. Aetna's Affirmative Action responsibilities extend to women, minorities, persons with disabilities and veterans. Company policy also provides for equal opportunity for qualified individuals regardless of race, color, sex, national origin, religion, age, disability, veteran status, sexual orientation, gender identity or marital status.