Senior Risk Adjustment Program Manager

3 weeks ago

Carrollton, United States DFW Healthcare MSO Full time
Job DescriptionJob Description

Senior Risk Adjustment Program Manager

IntraCare Health Center (DFW Healthcare MSO) operates owned and affiliated Primary Care Clinics in the greater Dallas-Ft. Worth and Phoenix metropolitan areas. Led by an exceptional leadership team, the company has delivered over a decade of strong performance and service excellence in value-based care and clinic operations.

IntraCare is an exceptional place to work The company has grown 300% in 2023 and poised to do the same in 2024, beyond that, the company is entering Medicare Advantage Risk with our owned providers and use our depth in Risk Management to drive performance. We are culturally driven to be inclusive and respectful of all opinions. We encourage diversity in thought and approach; and we welcome healthy debate. We hire partners who add to our IntraCare family, versus workers. We empower our employees and help them to achieve their personal best. This uncompromising dedication to team culture and individual development is key to our success.

Summary

Reporting to the Associate Vice President of Value-Based Care, the Senior Risk Adjustment Program Manager will identify improvement opportunities and provider performance trends, direct the implementation of new technologies, manage vendors, and deliver routine executive and board-facing reporting on the performance of Medicare risk adjustment programs. Ideally this candidate will have a proven track record of improving Medicare Advantage and Medicare Shared Savings Program contracts’ value through HCC coding accuracy and complete capture by developing, implementing, monitoring, and improving clinical and operational programs in an environment of both affiliate and employed primary care providers. Expertise with value-based care risk program concepts is a must. The candidate must have high comfort viewing, manipulating, and combining reports to ensure data-driven decision making and to ensure optimal application of all related technology investments; this includes a depth of independent, hands-on analysis meaningful to operating the program. The Senior Program Manager must routinely evaluate operational activities and their projected and proven contribution to medical loss ratios on risk programs as the owner for results of the risk adjustment programs.

This confident self-starter will be expected to demonstrate leadership and professionalism, especially while engaging with physicians, clinic leaders and corporate executives. Collaborative interpersonal skills and strong critical thinking capabilities will help the Senior Program Manager interact across various functions and align key internal and external players with the objectives for program success. This pathway may include but will not be limited to: provider and staff education planning; collaboration with finance and marketing to develop or modify incentive programs and associated materials; vendor procurement, deployment, and management; and direct management of coders and coding educators, depending on the direction of the program.

Key Responsibilities:

  • Oversee all risk adjustment programming and provide insightful reporting on trends, opportunities and progress across the organization’s Medicare contracts.
  • Develop programs to continuously improve the quality and comprehensiveness of HCC coding.
  • Measure and monitor, on a routine weekly and monthly basis, the activities of the department and its projected contributions both directly to risk adjustment and indirectly to medical expense savings.
  • Ensure optimal application of technologies available to support risk adjustment programs, collaborating closely with payors, vendors, IT, and other teams as necessary to achieve goals.
  • Develop professional plans and materials that support the educational and training needs of the organization by collaborating with internal departments and independent review.
  • Serve as subject matter expert for risk adjustment programs collaborating directly with health plans and ensure provider network and internal staff have access to health plan resources as appropriate for coding training and improvement.
  • Document Standard Operating Procedures and workflows for all department processes.
  • Collaborate with Compliance to ensure all risk adjustment programs meet the guidelines of the Centers for Medicare & Medicaid Services (CMS).
  • Familiarity with HCC coding related data exchange files and processes, including acquaintance with standards of revenue cycle management in Medicare.
  • Excellent organization and documentation skills with high detail orientation.
  • Excellent instincts for root cause analysis and problem solving.
  • Strong time management skills. Abilities to prioritize effectively and to work efficiently and independently to meet established deadlines.
  • Must possess a high degree of accuracy, efficiency, and dependability.
  • Experience with vendor management, offshore a plus.
  • Working knowledge of and the ability to use common project management tools such as SmartSheets.
  • Intermediate to advanced Excel skills in addition to proficiency in MS Office Word, Outlook, and PowerPoint.
  • Drive to build out a risk adjustment program focused on achieving accurate risk adjustment and operational proficiency to manage it.
  • Experience launching a technology solution.
  • Preferably have experience working with Medicare Advantage payers and Medicare Shared Savings Program (MSSP).

Education and Experience:

  • Bachelor’s degree in related field or equivalent experience
  • 5 – 7 years of program or project management experience with progressive responsibility
  • At least 2 years of experience in value-based healthcare and Medicare risk adjustment programs
  • At least 2 years of staff management experience or 5 years of cross-functional project leadership
  • Ten or more years of healthcare-related experience
  • Certified coder with CPC or CRC, preferred.

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