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Senior Director of Risk Management
2 months ago
Director, Risk Adjustment
Job Category: Accounting & Finance Requisition Number: DIRRI01579
Job Overview
The Director of Risk Adjustment plays a pivotal role in enhancing the quality of care provided to our members by delivering precise and timely analytics and insights. This position encompasses the execution of various risk adjustment initiatives and the integration of our risk adjustment efforts 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 closely with the Senior Director of Population Analytics to formulate a vision and strategy aimed at enhancing the acquisition, collection, reporting, and auditing of data pertinent to Risk Adjustment.
- Exhibit leadership and foresight by proactively identifying new opportunities in risk adjustment, including the design and promotion of innovative initiatives and reporting enhancements.
- Stay abreast of industry developments by attending conferences and engaging with experts from health plans and vendor partners nationwide.
- Work alongside senior leadership to pinpoint and implement crucial analytics projects that enhance organizational performance in risk adjustment metrics.
- Establish and maintain strong relationships with delivery system partners to inform and ensure the success of plan-driven initiatives.
- Act as the primary liaison with state and federal regulatory bodies.
- 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 guarantee accuracy and effectiveness.
- Ensure program integrity by adhering to CMS guidelines related to coding and data submission, managing audit and quality functions of all risk adjustment data before and after submission, including RADV audits.
- Foster a cohesive and motivated team environment through clear direction, high expectations, and effective delegation of responsibilities.
- Manage departmental budget and oversee multiple vendor contracts while ensuring vendor 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 of experience 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:
- Proven problem-solving skills, with the ability to assist others in navigating complex challenges.
- Strong performance management capabilities, with a focus on accountability and goal achievement.
- In-depth knowledge of risk adjustment requirements and their implications for the organization.
- Exceptional analytical skills, with the ability to interpret data and formulate actionable plans.
- Effective communication skills, both verbal and written.
- Demonstrated organizational and project management skills, with the ability to manage multiple priorities effectively.
This job description aims to outline the general content and requirements for satisfactory performance in this role. It is not intended to be an exhaustive statement of duties, responsibilities, or requirements. Community Health Plan of Washington is an equal opportunity employer committed to fostering a diverse and inclusive workforce.
