Operations Vice President, Risk Adjustment

Operations Vice President, Risk AdjustmentJoin to apply for the Operations Vice President, Risk Adjustment role at ArchWell HealthOperations Vice President, Risk Adjustment1 week ago Be among the first 25 applicantsJoin to apply for the Operations Vice President, Risk Adjustment role at ArchWell HealthGet AI-powered advice on this job and more exclusive features.Job Summary:The Vice President, Risk Adjustment is a key senior level leader responsible for the strategic design, implementation and oversight of the organization’s risk adjustment program. This individual ensures accurate, compliant and optimized risk capture processes to support revenue integrity and population health strategies in Medicare Advantage. The ideal candidate brings deep expertise in CMS-HCC risk adjustment, clinical documentation improvement and has proven ability to lead high performing teams in a matrixed environment. Collaborate with other departments including finance, medical economics, market and executive leadership, revenue cycle and other key stakeholders.Vice President, Risk AdjustmentJob Summary:The Vice President, Risk Adjustment is a key senior level leader responsible for the strategic design, implementation and oversight of the organization’s risk adjustment program. This individual ensures accurate, compliant and optimized risk capture processes to support revenue integrity and population health strategies in Medicare Advantage. The ideal candidate brings deep expertise in CMS-HCC risk adjustment, clinical documentation improvement and has proven ability to lead high performing teams in a matrixed environment. Collaborate with other departments including finance, medical economics, market and executive leadership, revenue cycle and other key stakeholders.Duties and Responsibilities:Develop and execute enterprise-wide risk adjustment strategy to align with regulatory requirements and financial objectivesOversee all aspects of risk adjustment including data analytics, coding accuracy, clinical documentation improvement strategy and vendor managementLead cross functional teams including coding, analytics, compliance, medical economics and operations to ensure seamless integration of risk adjustment initiativesMonitor and ensure compliance with CMS, health plans, and state specific regulations and audit requirementsLead end-to-end timely and accurate submission of risk adjustment data to CMS including overseeing the reconciliation of CMS MAO-004 reports to validate submission accuracyTranslate risk adjustment performance into actionable insights to support medical management and quality initiativesDrive innovation and efficiency in risk capture methodologiesPartner with finance, actuarial, operations teams to forecast, track performance and manage risk score impacts for all contracted productsCollaborate with Chief Clinical Officer on provider education needs to ensure documentation and coding accuracyEvaluate and manage relationships with third party vendors providing risk adjustment servicesServe as internal subject matter expert on all aspects of risk adjustment policy changes and risk scoring methodologiesExecutive level reporting identifying actual to expected performance, outlier trends and prevalence opportunitiesPromote a culture of accountability, innovation and complianceRequired Skills/Abilities:Expert level knowledge of CMS-HCC models V24 and V28, claims data lifecycle and submission systemsExcellent communication, executive presence and relationship building skillsStrong operational knowledge of coding standards (ICD-10, HCC) and clinical documentationExperience working with large payer networks and risk adjustment third party vendorsStrategic thinker with excellent analytical, critical thinking, problem-solving, interpersonal, and relationship building skills.Minimum Qualifications:Bachelor’s degree in healthcare administration, accounting, finance, or related field; Master’s degree MBA, MHA, MPH preferred10+ years of experience in risk adjustment, Medicare Advantage or related healthcare operationsStrong understanding of healthcare economics, population health and value-based care frameworksEmbodies and serves as a role model of ArchWell Health’s Values:Be compassionateStrive for excellenceEarn trustShow respectStay resilientAlways do the right thingAbout ArchWell Health:At ArchWell Health, we’re creating a community of caring designed to help our members stay healthy and engaged. By focusing on a strong provider-patient relationship, routine wellness, and staying active, our members enjoy a higher level of care and better quality of life after the age of 60. Everything we do is for seniors. We believe seniors should be heard, listened to, and given ample time by their physicians to live well later in life.Our value-based care model is designed to prevent illnesses while keeping members healthy and happy in every aspect of their life. We deliver best-in-class primary care at comfortable, accessible neighborhood centers where older adults can feel at home and become part of a vibrant, wellness-focused community. We’re passionate about caring for older adults and united by the belief that caring has the power to change everything for our members.ArchWell Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected classification.Seniority levelSeniority levelExecutiveEmployment typeEmployment typeContractJob functionJob functionFinance and SalesIndustriesHospitals and Health CareReferrals increase your chances of interviewing at ArchWell Health by 2xGet notified about new Vice President of Risk jobs in Nashville, TN.Nashville, TN $120,000.00-$150,000.00 1 day agoWe’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI. #J-18808-Ljbffr