Director, Medicare Risk Adjustment

2 weeks ago

Mclean, United States Somatus Full time

Overview

The Director, Medicare Risk Adjustment (MRA) will lead the execution strategy and implementation of the organization's Risk Adjustment Programs to optimize the programs' clinical benefit, financial accuracy and ensure program compliance with governing bodies' regulations, including the Center for Medicare and Medicaid Services. This role will partner with leadership to facilitate decision-making based on strategic and tactical recommendations for program improvements. This position will report to the Group President of Operations.

This position requires you to be on site at our HQ in Mclean, VA.

Responsibilities

* Accountable for the MRA program including all aspects of the various methods of executing on an MRA strategy (e.g. prospective, retrospective, concurrent approaches).
* Lead risk adjustment operational programs aimed at monitoring, oversight, and compliance for risk score accuracy.
* Responsible for the program to meet full compliance with state, federal and partner requirements.
* Drives industry best practices and performance results focusing on driving key KPI's (# visits, RAF score, coding accuracy).
* Manage a coordinated, cross functional and integrated process across the organization to implement programs and streamline activities.
* Develop program goals and key performance indicators (KPIs) to ensure accountability across the organization.
* Partner with Finance and Analytics team to establish risk adjustment analytics such as predictive modeling for coding improvement opportunities, provider coding improvement opportunities, provider coding accuracy, risk score trending and tracking, and transfer payment accruals.
* Partner with cross functional team and external vendors to execute MRA strategy.
* Coordinate with the provider Network Management and the Quality Program to implement tactics for risk adjustment optimization, particularly for provider and member engagement activities.
* Manage processes needed to conduct at home wellness visits.
* Ensure accurate coding for documentation and auditing.
* Collaborate with payer partners and manage key vendor relationships and perform oversight of vendors for performance management and service level adherence.
* Ensure processes and tools required for best-in-class accurate recapture rate.
* Assist provider engagement and operations teams to maximize efficiency of provider conducted MRA visits.
* Oversee and manage the compliance and performance of vendors or third-party administrators performing risk adjustment activities.
* Drive effective auditing documentation practices.

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

Qualifications

Required Education and Experience:

* Bachelor's degree in business in business, healthcare administration, or related field.
* 8+ years of successfully leading and executing a comprehensive MA MRA program at scale.
* Minimum 5 years of healthcare experience with knowledge of health plan operations i.e. Claim processing, customer service, enrollment etc.
* Proven experience with commercial and/ or Medicare Advantage risk adjustment functions.
* Proven track record of working collaboratively with clinical and operational colleagues across the organization.

Knowledge, Skills, and Abilities:

* Ability to communicate effectively and sensitively with clinicians and care teams in stressful situations.
* Ability to lead by influence to engage colleagues and lead teams cross-functionally.
* Experience in fostering networks with internal and external stakeholders.
* Possess strong business acumen, excellent strategic thinking, and effective problem-solving skills.
* Excellent verbal and written communications skills with demonstrated ability to communicate, present, and influence both credibly and effectively at all levels of an organization, including executive and C-level.
* Ability to work in a rapidly changing, matrixed environment.
* Proven ability to independently lead complex projects requiring cross functional alignment.
* Ability to be highly organized and systematic.

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice. Our priority is the health and safety of our members, colleagues, partners, and community. Proof of COVID-19 Vaccination is required for employment. If you are unable to be vaccinated for medical reasons or sincerely-held religious beliefs, we will consider requests for reasonable accommodations consistent with our policy, and where we are able to provide such accommodations without undue hardship to the company pursuant to applicable law. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Somatus, Inc. provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, or any other characteristic protected by state, federal, or local law. Further, the company takes affirmative action to ensure that applicants are employed, and employees are treated during employment without regard to any of these characteristics. Discrimination of any type will not be tolerated.

  • Director, Medicare Risk Adjustment

    2 weeks ago

    McLean, United States Somatus Full time

    The Director, Medicare Risk Adjustment (MRA) will lead the execution strategy and implementation of the organization’s Risk Adjustment Programs to optimize the programs’ clinical benefit, financial accuracy and ensure program compliance with governing bodies’ regulations, including the Center for Medicare and Medicaid Services. This role will partner...

  • Operational Risk and Controls Senior Director

    2 weeks ago

    McLean, United States Federal Home Loan Mortgage Corporation Full time

    As Senior Director in the Single-Family (SF) Acquisitions Division Quality Control and Operational Risk Management (QCORM) department, you will be responsible for the first line of defense operational and model risk management. The Senior Director w Risk, Controls, Director, Senior, Office, Operation, Manufacturing

  • Risk and Opportunity Analyst I

    3 weeks ago

    McLean, United States Rippling Full time

    Tier Tech International, Inc. (TTI) is a Service Disabled Veteran Owned Small Business (SDVOSB) with world-class, professional, and dedicated program and project leaders with decades of real world emergency preparedness and response, exercise and training, policy, and operational experience, supporting most U.S. Government response organizations. Our program...

  • Risk and Opportunity Analyst II

    2 weeks ago

    McLean, United States Rippling Full time

    Tier Tech International, Inc. (TTI) is a Service Disabled Veteran Owned Small Business (SDVOSB) with world-class, professional, and dedicated program and project leaders with decades of real world emergency preparedness and response, exercise and training, policy, and operational experience, supporting most U.S. Government response organizations. Our...

  • Deputy National Intelligence Manager for Military Integration

    3 weeks ago

    McLean, United States Office of the Director of National Intelligence Full time

    Summary The Office of the Director of National Intelligence (ODNI) Directorate for Mission Integration (MI) creates a consistent and holistic view of intelligence from collection to analysis and serves as the Director of National Intelligence's (DNI) principal advisor on all aspects of intelligence. MI integrates mission capabilities, informs...

  • Cyber Strategy and Resource Officer

    3 days ago

    McLean, United States US Office of the Director of National Intelligence Full time

    **Duties**: Lead the NIM-Cyber team's efforts for all steps of the Intelligence Planning, Programming, Budget, and Evaluation cycle including the Intelligence Planning Guidance, Consolidated Intelligence Guidance, and all other tasks pertaining to IC resource prioritization and engagement to raise the capabilities of the Cyber Intelligence...

  • Strategic Programs Director

    3 weeks ago

    McLean, United States Link Solutions, Inc. Full time

    Job DescriptionLink Solutions, Inc. is seeking a Strategic Programs Director to join our team and oversee strategic aspects of our organizational initiatives.Must be a US Citizen Fully RemoteThe Strategic Programs Director works directly with the executive team to lead growth activities and oversees the daily operations of a portfolio of...

  • Site Director

    5 days ago

    McLean, United States ID.me Full time

    Role Overview ID.me is seeking a Site Director to manage the ongoing operations of our McLean Headquarters for our Member Support organization. This role will be responsible for overseeing all operations along with ongoing support, and being a culture ambassador for the office as a whole. If you have a strong operational background, a drive to join a fast...

  • Business Director, Commercial Bank Bizops

    5 days ago

    McLean, United States Capital One Full time

    Center 1 (19052), United States of America, McLean, Virginia Business Director, Commercial Bank BizOps In late 2015, Capital One’s Commercial Banking division vaulted into the top 10 list of national commercial banks after a multi-year strategic investment in transforming Commercial from a collection of small local banks into a strong regional player....

  • Assurance Director, Nonprofit

    6 days ago

    McLean, VA, United States BDO International Full time

    Job Summary:The Assurance Director title is reserved for professionals who achieve recognition in a technical area of assurance and risk management. The person is qualified to perform certain limited yet critical additional technical functions as an Engagement Director or as a Concurring Reviewer. These additional responsibilities are conferred only as...

  • Physician - Primary Care McLean

    2 weeks ago

    McLean, United States VHC Health Full time

    Physician - Primary Care McLean Job Description Purpose & Scope: The physician is a member of the healthcare team who works in collaboration with other staff to provide comprehensive healthcare services to patients. The scope of practice of each physician is defined through the health system’s credentialing and privileging committee. The Physician...

  • Physician - Primary Care McLean

    2 weeks ago

    McLean, United States VHC Health Full time

    Physician - Primary Care McLean Job Description Purpose & Scope: The physician is a member of the healthcare team who works in collaboration with other staff to provide comprehensive healthcare services to patients. The scope of practice of each physician is defined through the health system's credentialing and privileging committee. The Physician...

  • Managing Director, Specialized Tax Services Partnerships

    6 days ago

    McLean, VA, United States BDO International Full time

    Job Summary:The Tax Managing Director, Partnerships is responsible for advising clients on the tax implications of their business objectives and various partnership specific items including but not limited to section 704(b) and taxable income allocations, capital account maintenance, liability analysis and allocations, section 734(b) and 743(b) adjustment...

  • Senior Principal Network Engineer

    4 weeks ago

    McLean, United States DTCC Full time

    Are you ready to make an impact at DTCC?Do you want to work on innovative projects, collaborate with a dynamic and supportive team, and receive investment in your professional development? At DTCC, we are at the forefront of innovation in the financial markets. We're committed to helping our employees grow and succeed. We believe that you have the skills and...

  • Cloud Administrator

    3 days ago

    McLean, United States Cornerstone Defense Full time

    Title: Cloud Administrator Location: McLean, VA *Clearance: *Active TS/SCI w/ Polygraph needed to apply * Company Overview: Cornerstone Defense is the Employer of Choice within the Intelligence, Defense, and Space communities of the U.S. Government. Realizing early on that our most prized assets are our employees, we continually focus our attention on...

  • Physician - Primary Care McLean (Full Time)

    2 weeks ago

    McLean, United States VHC Health Full time

    Physician - Primary Care McLean (Full Time) Job Description Purpose & Scope: The physician is a member of the healthcare team who works in collaboration with other staff to provide comprehensive healthcare services to patients. The scope of practice of each physician is defined through the health system’s credentialing and privileging committee. The...

  • Physician - Primary Care McLean (Full Time)

    2 weeks ago

    McLean, United States VHC Health Full time

    Physician - Primary Care McLean (Full Time) Job Description Purpose & Scope: The physician is a member of the healthcare team who works in collaboration with other staff to provide comprehensive healthcare services to patients. The scope of practice of each physician is defined through the health system's credentialing and privileging committee. ...

  • Office Management Staff Officer

    4 weeks ago

    McLean, United States Integrated Intel Solutions Full time

    Job DescriptionJob DescriptionOffice Management/Staff OfficerOverall Assignment Description:Support for the FMB Chief of Staff (CoS/DCoS) and FM Directors offices. Contractor shall ensure the efficient execution of NGAs business support operations, executive and administrative programs necessary for FM. The Contractor shall provide general and/or specialized...

  • Tax Manager/Senior Manager

    3 weeks ago

    McLean, United States Andrews & Cole, LLC Full time

    RESPONSIBILITIES: The Tax Manager will be part of an in-house team and have a range of responsibilities including federal and state tax planning, leading strategic projects, assisting with a variety of compliance matters, and implementing key process improvements for the tax department. A key part of the role will be to work with our Investor Relations Team...

  • Operations Technology Manager

    3 weeks ago

    McLean, United States Eco Financial Full time

    Job DescriptionJob DescriptionThe Operations Technology (OT) Manager is responsible for overseeing and managing the implementation, maintenance, and optimization of technology systems and solutions deployed across the terminal. The OT Manager works closely with cross-functional teams and related vendors to ensure the efficient and effective use of technology...