Risk Adjustment and Revenue Associate Director

Minneapolis, Minnesota
Apr 25, 2020
Jul 21, 2020
Employment Status
Full Time
Health Care that Starts with You!

Join a truly mission-driven organization! Independent, nonprofit UCare is recognized as one of the Minnesota's leading health plans. We provide more than 225,000 members across Minnesota and western Wisconsin with the health coverage plans and services they need to maintain and improve their health. The innovative coverage we create makes a difference for Medicare-eligible individuals, individuals and families enrolled in Minnesota Health Care Programs, such as MinnesotaCare and Medical Assistance, and disabled adults with special health care needs.

UCare is growing in size, membership, products, geographic coverage, and employees. We're an organization that's going places. Be part of a team that cares about you, be part of UCare.


Enter a highly collaborative environment where people are truly engaged, and feedback is valued. You'll enjoy a competitive salary and benefits, as well as a host of other perks, including a nationally recognized wellness program, and a bright, open, award-winning office space in Northeast Minneapolis just minutes from major freeways and retail centers.

At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.




UCare offers Medicare, Medicaid, Individual and Family health plans - powered by the hardest working people in the industry. Our people powered teams de-complicate, advocate and always go the extra mile to help our members. We serve with integrity, compassion and commitment to do right by members, providers and government partners. Above all, we come to work excited to provide members a path for the best health of their lives.


Working at UCare is more than a career; it's a mission. A mission that defines us as professionals, unites us as an organization and shapes how we interact with our members and each other. Employees join UCare and stay because of the opportunity to have a purpose-driven job.

Our strong culture has established UCare as a Star Tribune Top 150 Workplace for 11 consecutive years since the awards program began. It's a culture that embraces innovative ideas, strategic partnerships, and exemplary customer and provider experiences. Working at UCare is being a part of a people powered team dedicated to making a real difference in the lives of our members and communities.


Position Description

This position is responsible to lead risk adjustment and revenue reporting including; strategic modeling, projections, and encounter data submissions oversight across all lines of business. Oversee the reporting and data sharing for the contracted prospective and retrospective vendors for estimating and modeling anticipated CMS Medicare payment and ACA market reconciliations. Support and collaborate with Accounting Department on revenue projections and accruals, Compliance Department on data validations, annual work plans, and reviews, and the Provider Relations and Provider Reporting Teams on Provider facing analytics. Oversee development of the CMS benchmarks and risk score projections the annual CMS bids. Maintain benchmark reporting of overall revenue results and projections based on key indicators from enrollment, encounters, and risk adjustment activities.

• Lead organizational revenue reporting and analysis including interim reporting for management, modeling of regulatory payment changes, new models, and projection development.

• Oversee analytics and monitoring of member risk scores by line of business, product, region, living status, care system, etc. Identify opportunities and develop strategies for revenue accuracy and enhancement.

• Build relationships with UCare's current prospective and retrospective/clinical vendors to ensure optimization of CMS payments. Research and recommend additional or new vendors to support strategic revenue and/or risk adjustment initiatives across all lines of business.

• Provide support and collaboration with the HCE Encounters Team ensuring accurate and timely submissions to each regulator. Coordinate data submission and review status with Encounters team to ensure accuracy of accepted records and identify upstream operational and eligibility opportunities. Monitor reconciliations between encounter submissions and claims data sources for completeness and identify missing or incomplete data issues with regulator.

• Lead projections and analytics process for the annual CMS Part C and D risk scores, Part C benchmarks and payment estimates, and estimated projection factors based on CMS instructions and consulting actuarial guidance. Maintain up to date reporting of actual results to projected, identify and research variances from projections.

• Maintain a strong understanding of UCare revenue sources and payment processes. Monitor and analyze changes due to CMS guidance, DHS guidance, ACA/MN Exchange, or other modifications to payment models and payment processes impacting UCare.

• Collaborate with Accounting department leadership to accurately predict revenue adjustments for the CMS payment updates and the annual health care exchange reconciliation process. Support the Provider Relations and Contracting Team and HCE Provider Reporting Team explain revenue line item discrepancies. Meet with interested providers when called upon to explain revenue through risk adjustment mechanisms.

• Partner with compliance team for regulatory data validations and internal data reviews.

• Champion the importance of risk adjustment payment methodologies and DHS payment & risk adjustment methodologies including encounter data requirements and working collaboratively with internal areas including IT.

• Represent Health Care Economics on UCare cross-departmental projects and workgroups as an active contributor and supporting resource.

• Assist Senior Leadership with strategic product, provider and organizational initiatives.

• Lead and develop a growing team of analysts.

• Ad Hoc analysis to support stakeholders or other departments as needed.

• Other projects and duties as assigned.


B.A./B.S. in Finance, Economics, or related field.

Required Experience

Five years of leadership experience at manager. Strong financial analytics background and technical skills. Five years of Health Care/Risk Adjustment experience.

Preferred Experience

Finance planning and analysis experience, preferably in a large healthcare organization. Knowledge using SQL, Python, SAS, or other statistical software preferred.


The UCare difference is our people power - employees actively working on the behalf of our members to get them access to the health care they need. We value and respect each individual's ideas and contributions, and provide the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, and a myriad of volunteer activities. If you're looking for an inclusive environment that celebrates your people power, helps you build on your strengths and gives you the opportunity to truly make a difference, we invite you to apply.

As an Equal Opportunity/Affirmative Action Employer, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.

Similar jobs

More searches like this

Similar jobs