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Head of Risk Adjustment Strategies
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 for our members by delivering precise and timely analytics and insights. This position is responsible for overseeing a comprehensive suite of risk adjustment initiatives and integrating our risk adjustment efforts into a cohesive, year-round strategy. The Director will manage a team of skilled professionals, collaborate across various departments, and remain informed about the latest developments and technologies in risk adjustment.
Key Responsibilities
- Collaborate closely with the Senior Director of Population Analytics to establish a clear vision and strategy aimed at improving 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 trends by attending relevant conferences and engaging with experts from health plans and vendor partners nationwide.
- Work with senior leadership across the organization to pinpoint and implement critical analytics projects that enhance performance on risk adjustment metrics.
- Develop and maintain strong, trusting relationships with delivery system partners to ensure the success of plan-driven initiatives.
- Act as the primary liaison with state and federal regulatory agencies.
- Lead a cross-functional team tasked with capturing, analyzing, and reporting risk adjustment data for Medicare, Medicaid, and Commercial products.
- Direct risk adjustment programs to ensure both accuracy and effectiveness.
- Ensure program integrity by adhering to CMS guidelines related to coding and data submission, and manage audit and quality functions of all risk adjustment data before and after submission.
- Foster a cohesive and motivated team environment through clear direction, high expectations, and effective delegation of responsibilities.
- Manage the department budget and oversee multiple vendor contracts.
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 required.
Skills and Abilities:
- Strong analytical skills with the ability to interpret, evaluate, and formulate actionable plans based on data.
- Demonstrated ability to solve complex problems independently and guide others in achieving desired outcomes.
- Proficient in advanced analytics tools such as SQL, Access, and Excel.
- Effective verbal and written communication skills, with a capacity to collaborate respectfully with others.
- Ability to manage multiple priorities and work under pressure while meeting deadlines.
This job description is intended to outline the general content and requirements for satisfactory performance in this position. It is not to be construed as an exhaustive statement of the duties, responsibilities, or requirements of this position.
Community Health Plan of Washington is an equal opportunity employer committed to fostering a diverse and inclusive workforce.
