Head of Risk Adjustment

Responsible for ensuring the organization has a comprehensive, efficient and compliant documentation integrity program (risk adjustment and HEDIS/Stars Quality measure documentation). Works directly with clinicians, certified coders, IT, enterprise analytics, network management and physicians. Owns accountability for ensuring our members’ medical record is complete, accurate and represents accurate member conditions. This role will work closely with the Quality/Accreditation teams, Customer Service and Call Center Teams, Provider Services Team, Nurse Practitioners, and Clinical Program Teams.Applies in-depth knowledge of risk adjustment methodology to partner with key stakeholders in improving outcomesProvider profiling, engagement and education programsDevelops and implements provider education strategies and tools, monitors provider performance, develops improvement plans and assists physicians/care teams to ensure patients are accurately assessed for medical conditionsComposes and distributes education materials to physicians and vendors to aid the collection of complete and accurate member profile documentationStays informed of all risk related program requirements from CMS and develop implementation strategies to CMS requirementsPerforms management responsibilities including hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity; has budgetary responsibility and authority10 or more years related experience including: 5+ years of experience in Managed Care, large medical group / IPA, Payer Provider Health Plan, Health system management.5+ years of experience in risk adjustment and HEDIS/STARS (Medicare Advantage/commercial).5+ years of experience with Chart Review, In Home assessment, Provider education, Prospective programs and encounter submissions; knowledge of billing rules and systems6 years of management experience 5 years of demonstrated experience with reporting and analytical tools (power BI, Tableau, etc)Experience driving results and influencing across a wide array of stakeholders Risk Adjustment experience in Managed Care, large medical group / IPA, Payer Provider Health Plan, Health system management.Knowledge within RAF markets (Medicare Advantage/commercial).HEDIS/STARS data abstraction and reporting experience in Managed Care, large medical group / IPA, Payer Provider Health Plan, Health system management.Chart Review, Annual Health Assessment (AHA/AWV), Provider education, Prospective programs and encounter submissions; knowledge of billing rules and systemsManagement experience and ability to be a servant leader who rolls up their sleeves to both do the work, coach the team, and be a strategic thinker to drive the program forwardDeep analytical skills to leveraging data to formulate insights and drive decisions. This includes manipulating and understanding data to craft data-driven messages, as well as thinking of new ways to draw insights from data.Strong skills in influencing without authority* Expert at building relationships with a broad range of internal and external stakeholders.**Base Salary**$165,000 - $220,000/yr**You Share Our Mission & Values:****Compassion**We act with empathy and a deep respect for the challenges faced by physicians and their patients. Our work is driven by a genuine commitment to improving lives and ensuring that care is delivered with dignity, understanding, and humanity.**Community**We foster a culture of collaboration--with physicians, patients across the healthcare ecosystem, and among our teams. By building strong, trusted relationships, we create a unified community focused on advancing patient care and physician well-being.**Leadership**We lead with integrity and vision, setting the standard for excellence in physician support and healthcare innovation. Through collaboration and expertise, we empower others to lead, drive change, and shape the future of care.**Excellence**We are relentlessly focused, results-driven, and accountable for delivering measurable value to physicians and the patients they serve. Our high standards reflect our commitment to excellence, operational discipline, and continuous improvement.**Agility**We embrace change as a constant and respond swiftly to the evolving needs of the healthcare industry. With flexibility and forward-thinking, we adapt, innovate, and act decisively to keep physicians at the forefront.Altais values the contribution each Team Member brings to our organization. Final determination of a successful candidate’s starting pay will vary based on several factors, including, but not limited to education and experience within the job or the industry. The pay scale listed for this position is generally for candidates that meet the specified qualifications and requirements listed on this job description. Additional pay may be determined for those candidates that exceed these specified qualifications and requirements. We provide a competitive compensation package that recognizes your experience, credentials, and education alongside a robust benefits program to meet your needs.*The anticipated pay range for this role is listed in our salary posting for transparency but may vary based on factors including the candidate’s qualifications, skills, and experience. This position will also be eligible to participate in our annual bonus program.*Altais and its subsidiaries and affiliates are committed to protecting the privacy and security of the personal information you provide to us. Please refer to our ‘CPRA Privacy Notice for California Employees and Applicants’ to learn how we collect and process your personal information when you apply for a role with us.External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.#J-18808-Ljbffr