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Director of Risk Adjustment and Compliance
1 month ago
We are seeking a highly skilled and experienced Director of Risk Adjustment and Compliance to join our team at Altais Health Solutions. As a key member of our organization, you will be responsible for ensuring the accuracy and completeness of our risk adjustment and HEDIS/STARS data.
Key Responsibilities- Develop and implement comprehensive risk adjustment and HEDIS/STARS programs to ensure compliance with federal and state regulations.
- Collaborate with cross-functional teams to design and implement documentation integrity programs that meet regulatory requirements.
- Lead the development of analytical and operational teams to deliver high-performing documentation integrity programs.
- Ensure that all documentation integrity programs are compliant with applicable federal and state guidelines.
- Develop and implement provider education strategies and tools to ensure accurate and complete member profile documentation.
- Stay up-to-date on all risk-related program requirements from CMS and develop implementation strategies to meet these requirements.
- Oversee the implementation of documentation integrity analytics platforms and related technological solutions.
- Bachelor's degree required.
- 10 or more years of related experience required.
- 5+ years of experience in Managed Care, large medical group / IPA, Payer Provider Health Plan, Health system management.
- 5+ years of experience in risk adjustment and HEDIS/STARS (Medicare Advantage/commercial).
- 5+ years of experience with Chart Review, In Home assessment, Provider education, Prospective programs and encounter submissions; knowledge of billing rules and systems.
- 6 years of management experience required.
- 5 years of demonstrated experience with reporting and analytical tools (Power BI, Tableau, etc).
Altais Health Solutions is a mission-driven organization dedicated to improving the healthcare experience. We are a growing and dynamic company with a passion for innovation and a commitment to excellence. We value diversity, equity, and inclusion and are an equal opportunity employer.
What We OfferWe offer a competitive compensation package, including a salary range of $120,000 - $180,000 per year, depending on experience. We also offer a comprehensive benefits package, including medical, dental, and vision insurance, 401(k) matching, and paid time off.
