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Vice President of Risk Adjustment Programs

2 months ago

Seattle, Washington, United States Community Health Plan of Washington Full time

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 by delivering precise and timely analytics and insights. This position is responsible for implementing a comprehensive range of risk adjustment initiatives and integrating our risk adjustment efforts into a cohesive, year-round program. The Director will oversee a team of skilled professionals, foster collaboration across various departments, and remain informed about emerging trends and technologies in risk adjustment.

Key Responsibilities:

  1. Collaborate closely with the Senior Director of Population Analytics to formulate a vision and strategy aimed at improving the acquisition, collection, reporting, and auditing of data pertinent to Risk Adjustment.
  2. Exhibit leadership and foresight by proactively identifying new opportunities in risk adjustment, including the design and promotion of innovative initiatives and reporting methodologies.
  3. Stay abreast of industry developments by attending conferences and engaging with experts from health plans and vendor partners nationwide.
  4. Work alongside senior leadership to pinpoint and execute critical analytics projects that enhance organizational performance in risk adjustment metrics.
  5. Establish and maintain trusting relationships with delivery system partners to inform and ensure the success of plan-driven initiatives.
  6. Act as the primary liaison with state and federal regulatory agencies.
  7. Lead a cross-functional team tasked with capturing, analyzing, and reporting risk adjustment data across Medicare, Medicaid, and Commercial products.
  8. Direct risk adjustment programs to guarantee accuracy and effectiveness.
  9. Ensure program integrity by adhering to CMS guidelines related to coding and data submission, managing audit and quality functions for all risk adjustment data pre- and post-submission.
  10. Develop a cohesive and motivated team through clear guidance, high expectations, and delegation of responsibilities.
  11. Manage departmental budget and oversee vendor contracts, ensuring effective vendor management.

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 of experience in healthcare, with a focus on healthcare analytics and/or risk adjustment, and at least four (4) years of experience in a leadership role managing staff.

Skills and Abilities:

  • Strong analytical skills with the ability to interpret and evaluate data to formulate actionable plans.
  • Demonstrated problem-solving capabilities, with a focus on achieving desired outcomes.
  • Effective communication skills, both verbal and written.
  • Ability to work in a matrix-management environment and manage multiple priorities under pressure.
  • Proficiency in Microsoft Office products and advanced analytic tools such as SQL, Access, and Excel.

This job description is intended to provide a general overview of the position and is not exhaustive of all responsibilities and qualifications. Community Health Plan of Washington is an equal opportunity employer committed to fostering a diverse and inclusive workforce.