Director, Risk Adjustment and Analytics

5 days ago

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

The Director, Risk Adjustment and Analytics will drive corporate success in achieving outstanding quality of care for our members by providing sharp and timely analytics and insight. This role will be 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 the Senior Director, Population Analytics to develop a 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 the 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 inform and ensure the success of plan-driven programs.
  • Serve as the primary point of contact with state and federal agencies.
  • Lead a 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 effectiveness.
  • 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 to and post-submission, including RADV audits.
  • Build a cohesive, motivated team through clear direction, high expectations, 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 budgets.
  • Negotiate and manage multiple vendor contracts and provide vendor oversight.
Requirements
  • 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 highly relevant experience.
  • Minimum seven (7) years of healthcare experience, preferably with a 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.
  • Employment eligibility, including a successful background check and no sanctions or exclusions from participation in federal or state healthcare programs.
Preferred Qualifications
  • Bachelor's or better in Business Administration or related field.
  • Bachelor's or better in Economics or related field.
  • Bachelor's or better in Health Administration or related field.
  • Bachelor's or better in Mathematical Sciences or related field.
  • Bachelor's or better in Statistics or related field.
  • Minimum four (4) years of experience leading and managing staff.
  • Minimum seven (7) years of healthcare experience, preferably with a focus in healthcare analytics and/or risk adjustment.
Work Environment

The Director, Risk Adjustment and Analytics will work in an office environment with frequent environmental exposure to low-grade radiation from computer monitors. The role will require the ability to manage conflict, communicate effectively, and meet time-sensitive deadlines.

Protected Health Information (PHI) Access

All information (written, verbal, electronic, etc.) that an employee encounters while working at Community Health Plan of Washington is considered confidential. The Director, Risk Adjustment and Analytics may be exposed to and required to deal with highly confidential and sensitive material and must adhere to Community Health Plan of Washington policies, guidelines, and all applicable laws and regulations at all times.

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