Vice President Risk Adjustment

3 days ago

Portland, United States Martins Point Health Care Full time

Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day. Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015.

Position Summary
The Vice President of Risk Adjustment works closely and collaboratively with Vice Presidents in the Health Plan and leaders across the organization to oversee the design, development, implementation, and execution of compliant risk adjustment strategies, programs, and initiatives for Martin's Point Health Care Generations Advantage Medicare Advantage product.

This position offers a remote work schedule with quarterly visits to Maine. Ideal candidates are those who are coming from a Health Plan and with strong Risk Adjustment and Medicare backgrounds.
Job Description

100Key Outcomes:

  • Risk Adjustment Strategy
    • Leads the health plan in the design and development of risk adjustment strategies to improve the accuracy of risk scores and reduce payment error risk.
    • Develops and communicates progress against Key Performance Indicators (KPIs) metrics in order to track and monitor department and organizational performance.
    • Supports and contributes to the development of revenue projections for Generations Advantage in concert with the CFO and Finance leadership.
    • Develops and maintains an expert level of knowledge of Medicare and risk-based reimbursement methodologies.
  • Operational Programs
    • Responsible for high level management of the risk adjust retrospective campaign strategy, including oversight of chart chase approach, coding of medical records, and coding audits.
    • Sets the vision and strategic plan for prospective programs to drive risk adjustment and quality value.
    • Facilitates network provider partnerships for risk adjustment managers/directors; creates and delivers on provider partnership strategies related to risk adjustment education and/or new initiatives.
    • Business owner and primary contact for vendor contracts supporting risk adjustment efforts including contract negotiation, setting goals and tracking performance, and analyzing program ROI; also responsible for evaluating which activities should be outsourced or insourced on an ongoing basis.
  • Data & Analytics
    • Oversees and ensures the accuracy and completeness of CMS encounter data submissions for the Health Plan.
    • Leverages data & analytics to ensure that risk adjustment programs and initiatives are effective, efficient, and contribute to the overall risk adjustment score outcomes.
    • Leverages data science and analytics to determine potential/new initiatives.
  • Compliance
    • Ensures development, implementation, and maintenance of risk adjustment policies and procedures in partnership with the Compliance department, and monitors department adherence to policies and procedures.
    • Provides strategic insight and oversight of key regulations and guidance, partners with the Compliance department on proposed and final rules and legislation, support regulation impacts to existing programs and helps to ensure any new program changes are implemented with changing regulatory landscape.
    • Develops and audits Risk Assessment Data Validation (RADV) readiness plan and monitoring program in collaboration with the Compliance department.
  • Leadership and Collaboration
    • Develops strong and collaborative relationships across the organization, especially with Quality (Stars), Clinical, and Network leadership.
    • Ensures that the risk adjustment team has the appropriate skills and expertise to meet ongoing business goals and initiatives.
    • Creates future leaders and staff bench strength within the team; and strategically aligns resources by continuously planning and organizing to meet initiatives.
    • Communicates and interacts effectively and professionally with employees, co-workers, and management.

We are an equal opportunity/affirmative action employer.

Do you have a question about careers at Martin's Point Health Care? Contact us at: jobinquiries@martinspoint.org

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