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Director of Risk Adjustment Strategy
2 months ago
The Director of Risk Adjustment drives corporate success in achieving outstanding quality of care for our members by providing sharp and timely analytics and insight. This role is responsible for executing on a broad array of risk adjustment programs and synthesizing our risk adjustment activities into a coordinated, year-round program.
Key Responsibilities- 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.
- Bachelors degree in Healthcare Administration, Business Administration or a quantitative discipline such as Mathematics, Statistics or Economics, or an equivalent combination of education and highly relevant experience required.
- 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.
- 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.
Office environment with frequent environmental exposure to low-grade radiation from computer monitors; fast paced with frequent interruptions.
Protected Health Information (PHI) AccessAll 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.
