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Senior Director of Risk Management
2 months ago
Position Title: Director, Risk Adjustment
Job Category: Accounting & Finance
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 is responsible for overseeing a comprehensive range of risk adjustment initiatives and integrating our risk adjustment efforts into a cohesive, year-round program.
Key Responsibilities:
- Collaborate closely with the Senior Director of Population Analytics to formulate a strategic vision aimed at optimizing 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 relevant conferences and engaging with experts from health plans and vendor partners nationwide.
- Work in partnership with senior management across the organization to pinpoint and implement crucial analytics projects that enhance performance on risk adjustment metrics.
- Establish and maintain trusting 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 dedicated to capturing, analyzing, and reporting risk adjustment data across Medicare, Medicaid, and Commercial products.
- Direct risk adjustment programs to guarantee precision and effectiveness.
- Ensure program integrity by adhering to CMS guidelines concerning coding and data submission, managing audit and quality functions for all risk adjustment data before and after submission, including RADV audits.
- Foster a cohesive and motivated team through clear direction, high expectations, and delegation of responsibilities.
- Oversee department budgeting and manage multiple vendor contracts while providing oversight.
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, and at least four (4) years of experience in a leadership role managing staff.
Skills and Abilities:
- Strong problem-solving skills, with the ability to guide others through complex challenges.
- Proficient in managing performance and holding individuals accountable for achieving goals.
- In-depth knowledge of risk adjustment requirements and their implications for the organization.
- Exceptional analytical skills, with the ability to interpret data and develop actionable plans.
- Effective communication skills, both verbal and written.
- Ability to work collaboratively in a matrix-management environment.
- Demonstrated organizational and project management capabilities.
- Ability to handle multiple priorities and meet deadlines.
This position requires a professional demeanor and the ability to maintain confidentiality. The work environment is office-based, with exposure to low-grade radiation from computer monitors and a fast-paced atmosphere with frequent interruptions.
Equal Opportunity Employer: Community Health Plan of Washington is committed to fostering a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to any actual or perceived protected characteristic or other unlawful consideration.
