Senior Director of Risk Management
7 days ago
Position Title: Director, Risk Adjustment
Job Category: Accounting & Finance
Job Overview:
The Director of Risk Adjustment plays a pivotal role in enhancing the quality of care for our members through precise analytics and insights. This position is responsible for the execution of various risk adjustment initiatives and the integration of these activities into a cohesive, year-round program. The Director will manage a team of skilled professionals, collaborate across various departments, and remain informed about the latest trends and technologies in risk adjustment.
Key Responsibilities:
- Collaborate with the Senior Director of Population Analytics to establish a strategic vision aimed at improving data acquisition, collection, reporting, and auditing related to Risk Adjustment.
- Exhibit leadership by proactively identifying new opportunities in risk adjustment, including the design and promotion of innovative initiatives and reporting methods.
- Stay abreast of industry developments by attending relevant conferences and engaging with experts from health plans and vendor partners nationwide.
- Work with senior leadership to pinpoint and implement critical analytics projects that enhance organizational performance in risk adjustment metrics.
- Foster strong, trusting relationships with delivery system partners to support the success of plan-driven initiatives.
- Act as the primary liaison with state and federal regulatory agencies.
- Lead a cross-functional team responsible for the collection, analysis, and reporting of risk adjustment data across Medicare, Medicaid, and Commercial products.
- Oversee risk adjustment programs to ensure their accuracy and effectiveness.
- Guarantee program integrity by adhering to CMS guidelines regarding coding and data submission, while managing audit and quality functions for all risk adjustment data.
- Develop a cohesive and motivated team through clear guidance, high expectations, and effective delegation of responsibilities.
- Manage departmental budget and vendor contracts, ensuring oversight and compliance.
Qualifications:
Education:
A Bachelor’s degree in Healthcare Administration, Business Administration, or a quantitative discipline such as Mathematics, Statistics, or Economics, or an equivalent combination of education and relevant experience is required.
Experience:
A minimum of seven (7) years in healthcare, with a focus on healthcare analytics and/or risk adjustment, is preferred. Additionally, at least four (4) years of experience in a leadership role managing staff is essential.
Skills and Abilities:
- Strong analytical skills with the ability to interpret and evaluate data effectively.
- Proven problem-solving capabilities, with a focus on achieving desired outcomes.
- Excellent verbal and written communication skills.
- Ability to work in a matrix-management environment and manage multiple priorities under pressure.
- Demonstrated proficiency in Microsoft Office and advanced analytic tools.
This position requires a professional demeanor, confidentiality, and the ability to travel as necessary. The role is situated in an office environment that may involve exposure to low-grade radiation from computer monitors.
Community Health Plan of Washington is an equal opportunity employer committed to a diverse and inclusive workforce.
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