Primary Duties:
- Lead or coach process owners and improvement teams in optimizing accurate coding, billing, documentation. Acting as the liaison for multiple teams in a matrixed environment. This includes collaboration with clinical, market teams and compliance/legal.
- Responsible for risk payer relationships. They will eventually lead the team who is responsible for tracking all diagnosis submissions through the entire risk process and our overall workflow.
- Work with payer to promote risk programs.
- Own reporting for meetings with payer leaders for our working groups related to work with Risk.
- Oversee development for reporting for all stages of the risk adjustment process.
- Work with BI and Impact Analytics to determine impact of various interventions.
- Serve as a key Business Stakeholder and RA subject matter expert for the BI and Analytics team.
- Act as the liaison with the analytics team to discuss risk trends the team has observed; understand patterns and assist with analytical interpretation.
- Collaborate and support the performance team with operational execution.
- Develop strategies and tactics to improve risk adjustment accuracy through technology/product and program enhancements.
- Work with internal and external stakeholders on projects and programs.
Minimum Qualifications:
- Bachelor’s degree in Healthcare Adm or Business (or appropriate equivalent training)
- 5+ years payer/healthplan/value based care company including Medicare and Commercial
- 5 + years risk adjustment including Medicare, MSSP
- Demonstrated knowledge and experience with risk adjustment methodologies such as HCC, 3M, Milliman, etc.
- 5+ years of program management, project leadership and execution experience in a healthcare or product related setting.
- 5+ years of management experience
- Strong data analytics skills
- Proficiency in Microsoft Office, Project/Product management, Google Suite
Preferred:
- MBA, MHA or other Master’s level training in health, business or IT
- 5+ years of program management, project leadership and execution experience in a healthcare or product related setting.
- Demonstrated leadership ability in prior workplace, including running teams and managing high import portfolio, with internally and externally facing representation responsibilities
- Advanced Microsoft Office, Project/Product manage, Analytics: SQL, PowerBI, SAS