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Salary: $150,000 – $200,000 per year
A bit about us:
On a mission to transform our health care system while creating a healthier community.
We are looking for someone that not only brings amazing leadership ability, but is also technical with SQL programming, data architecture, automation, analysis and reporting.
Why join us?
Outstanding salary and benefits are offered along with the opportunity to work with a 5-Star Plan! Apply today!
We enjoy an organizational culture of trust and respect, where our values – taking care of ourselves and others, continuous learning, helping each other, and having fun – are brought to life every day.
Certified as a “Great Place to Work” for over 7 years and running.
Dedicated Engagement and Learning department
Employee appreciation events
Job Details
The Director, Risk Adjustment & HEDIS Analytics develops and ensures effective execution of departmental strategic and operational plans in support of risk adjustment objectives. This role oversees and translates strategies into operational plans and sets the direction for revenue accuracy and risk adjustment efforts. This Director role is a key strategic leader responsible for driving Medicare Risk Adjustment activities and achievement of related revenue targets through alignment of risk adjustment data and analytics with organizational initiatives.
Job Description
- Leads the implementation of submission processes, data architecture, reporting, forecasting, and analytics for Risk Adjustment. Uses analytics to define Risk Adjustment focus and works with other leaders to align and optimize quality and risk adjustment metrics opportunities.
- Partners with Senior Leadership to plan the strategic direction of Risk Adjustment initiatives to facilitate achievement of complete and accurate diagnosis capture and sustainable business performance to achieve organizational goals.
- Leads the development of key analytics and data to support Risk Adjustment financial forecasts, analysis and reporting to engage key stakeholders and communicate results to the organization. Incorporates HEDIS, Stars, Quality, and other related activities into overall analytic strategy.
- Monitors, measures and effectively communicates Risk Adjustment performance and submission quality relative to the program strategy. Informs Senior Leadership of the anticipated impact of changes in regulations to risk score and revenue.
- Leads complex cross-functional analyses of large, multi-dimensional healthcare datasets to identify outcomes and trends, interpret and explain results, and discover opportunities for improvement.
- Engages Plan Leadership and Data Analytic staff in problem solving and process improvement activities to ensure efficient use of resources, and optimal, accurate revenue capture.
- Oversees an effective and optimal Risk Adjustment submission process and Quality Assurance program.
- Oversees approaches to accurately assess ROI of all risk adjustment program activities.
- Leads process to develop annual performance targets for both internal and external parties. Tracks progress against stated targets and assesses implications to forecast. Supports Operations with performance consultation to drive attainment of targets.
- Partners with Operational Leadership to solve business problems and find patterns and insights within structured and unstructured data. Drives discussions with Operational Leadership in tactical and strategic business decisions.
- Partners with Network Management to develop and distribute provider reporting and develop incentive programs for key provider groups as it relates to Risk Adjustment metrics and performance
- Provides insight and oversight to Product leadership, Medical Management leadership, CFO and Finance team in developing forecasts and Medicare bids. Leads efforts to tie the bid, budget, and operational outcomes of Risk Adjustment campaigns.
- Supports Senior leadership in developing annual business plan, including developing annual goals and identifying appropriate initiatives to advance the performance of Health Plans.
- Develops and maintains knowledge and expertise in regional and national Medicare trends and best practices, seeking opportunities to translate those toto environment.
- Develops and implements employee training, as needed, to improve Risk Adjustment performance. Mentors Plan Leadership and Data Analytics staff on best practices.
- Provides consultation to all levels of management relating to appropriate use of organizational data assets as they relate to Risk Adjustment activities, RA Revenue, and RAF Scores
Education/Experience:
- Bachelor’s degree in computer science, mathematics, finance, or related quantitative/analytic field is required. Master’s degree strongly preferred.
- 7 years of experience in progressively responsible analytical data management and reporting roles in a complex operational setting or consulting role.
- Experience working in the managed care or insurance sector for a health plan, provider group, healthcare ITA/ Management consultancy or auditing firm.
- Leadership and/or management experience required.
- Medicare risk adjustment experience required.
- Solid knowledge of the healthcare industry and cross–functional work experiences in areas such as health insurance, claims data, finance, medical economics, and actuarial.
Interested in hearing more? Easy Apply now by clicking the “Apply” button.
Source: Monster.com
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