Director, Risk Adjustment

** Director, Risk Adjustment**

**Job Category****:** Accounting & Finance **Requisition Number****:** DIRRI01579 Showing 1 location **Job Details**

**Description**

**Job Summary**

The Director, Risk Adjustment drives corporate success in achieving outstanding quality of care for our members by providing sharp and timely analytics and insight. Responsibilities include executing on a broad array of risk adjustment programs and synthesizing our risk adjustment activities into a coordinated, year-round program. The Director will lead a team of highly skilled professionals, collaborate across departments, and stays current on emerging ideas and technology related to risk adjustment.

**Essential Functions**

* Work closely with Sr Director, Population Analytics to develop vision and strategy to improve the acquisition, collection, reporting and audit of data related to Risk Adjustment.

* Demonstrate leadership and vision through proactive identification of new risk adjustment opportunities including design and promotion of new initiatives and reporting innovations.

* Stay current on industry trends, attending conferences and seeking out expertise from health plan colleagues and vendor partners across the country.

* Collaborate with senior leaders across the company to identify and execute key analytics projects to improve organizational performance on risk adjustment related measures.

* Build trusting and lasting relationships with delivery system partners to both inform and ensure the success of plan-driven programs.

* Serve as primary point of contact with state and federal agencies.

* Lead cross-functional team responsible for capturing, analyzing, and reporting risk adjustment data for Medicare, Medicaid and Commercial products.

* Direct risk-adjustment related programs to ensure accuracy and effect.

* Ensure program integrity through compliance with CMS guidelines related to coding and data submission. Manage audit and quality functions of all risk adjustment data prior and post submission, including RADV audits.

* Build a cohesive, motivated team through clear direction, high expectation and delegation of responsibility and accountability. Mentor staff in analytic and program management approaches, time management, and presentation of results. Determine future recruitment needs.

* Set and manage department budget.

* Negotiate and manage multiple vendor contracts and provide vendor oversight.

* Exempt Employees are expected to report to work as scheduled, participate in all assigned meetings, and meet established performance and accountability standards.

* Other duties as assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion.

**Qualifications**

**Education**

* Bachelors degree in Healthcare Administration, Business Administration or a quantitative disciple such as Mathematics, Statistics or Economics, or an equivalent combination of education and highly relevant experience required

**Experience**

* Minimum seven (7) years of health care experience, preferably with focus in healthcare analytics and/or risk adjustment.

* Minimum four (4) years of experience leading and managing staff.

* Experience with advanced analytic features of SQL, Access and Excel.

Employment Eligibility

* Complete and successfully pass a criminal background check

* Has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency

Knowledge, Skills, and Abilities

* Demonstrated independent and complex problem solving skills; including the ability to assist others in working through complex problems to meet desired outcomes.

* Ability to effectively manage and drive performance, and delegate and hold individuals and team accountable for goal achievement and overall performance.

* Knowledge of risk adjustment requirements and their impact on the organization.

* Strong analytical skills and the ability to interpret, evaluate and formulate action plans based upon data.

* Demonstrated ability to add insight and value to corporate initiatives, including program evaluation and innovation.

* Effective verbal and written communication skills

* Flexibility and willingness to work in a matrix-management environment

* Demonstrated organizational, time management, and project management skills

* Ability to multi-task and deal with complex assignments on a frequent basis

* Demonstrated proficiency and experience with Microsoft Office products

* Collaborate with others in a respectful manner

* Ability to hire, motivate and mentor team members, and plan and prioritize their work.

* Able to work under pressure and time constraints. Ability to handle multiple priorities and meet scheduled deadlines.

* Ability to travel as necessary.

* Ability to maintain a professional demeanor and confidentiality.

SENSORY/PHYSICAL/MENTAL REQUIREMENTS

**Sensory***:

* Speaking, hearing, near vision, far vision, depth perception, peripheral vision, touch, smell, and balance.

**Physical***:

* Extended periods of sitting, computer use, talking and possibly standing

* Simple grasp, firm grasp, fine manipulation, pinch, finger dexterity, supination/pronation, wrist flexion

* Frequent torso/back static position; occasional stooping, bending and twisting

* Some kneeling, pushing, pulling, lifting and carrying (not over 25 pounds), twisting and reaching

**Mental**:

* Must have the ability to learn and prioritize multiple tasks within the scope and guidelines of the position and its applicable licensure requirements, many requiring extremely complex cognitive capabilities. Must be able to manage conflict, communicate effectively and meet time-sensitive deadlines.

**WORK ENVIRONMENT**

Office environment with frequent environmental exposure to low-grade radiation from computer monitors; fast paced with frequent interruptions.

**PROTECTED HEALTH INFORMATION (PHI) ACCESS**

All information (written, verbal, electronic, etc.) that an employee encounters while working at CHPW is considered confidential. CHPW employees may encounter protected health information in the regular course of their work at and for CHPW. This position may be exposed to and required to deal with highly confidential and sensitive material and must adhere to CHPW policies, guidelines, and all applicable laws and regulations at all times.

**Candidates whose disabilities make them unable to meet these requirements are considered fully qualified if they can perform the essential functions of the job with reasonable accommodation.*

*This job description is intended to describe the general content and the requirements for satisfactory performance in this position. It is not to be construed as an exhaustive statement of the duties, responsibilities or requirements of this position.*

***Community Health Plan of Washington is an equal opportunity employer committed to a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to any actual or perceived protected characteristic or other unlawful consideration.***

**Qualifications**

**Skills**

**Behaviors**

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**Motivations**

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**Education**

**Preferred**

Bachelors or better in Business Administration or related field.

Bachelors or better in Economics or related field.

Bachelors or better in Health Administration or related field.

Bachelors or better in Mathematical Sciences or related field.

Bachelors or better in Statistics or related field.

**Experience**

**Preferred**

**4 years:** Minimum four (4) years of experience leading and managing staff.

**7 years:** Minimum seven (7) years of health care experience, preferably with focus in healthcare analytics and/or risk adjustment.

**Licenses & Certifications**

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

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