Risk Adjustment Program Manager
Risk Adjustment Program Manager
Employer Active
Job Alert
You will be updated with latest job alerts via email
Share
Job Alert
You will be updated with latest job alerts via email
Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
Mass General Brigham relies on a wide range of professionals including doctors nurses business people tech experts researchers and systems analysts to advance our mission. As a notforprofit we support patient care research teaching and community service striving to provide exceptional care. We believe that highperforming teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.
Job Summary
Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham we are on the forefront of transformation with one of the worlds leading integrated healthcare systems. Together we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage.Our work centers on creating an exceptional member experience a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds experiences and skills.
We are pleased to offer competitive salaries and a benefits package with flexible work options career growth opportunities and much more.
The Program Manager leads risk adjustmentrelated projects from conception to implementation to ongoing operations. The Program Manager will provide thought leadership project management vendor management and complex analytic work to ensure the success of the assigned project. The Program Manager will develop new ideas to continually improve the success of the risk adjustment activities within our company.
This role requires interacting and influencing internal and external stakeholders to ensure project success. The Program Manager will follow and document all CMS and MassHealth riskrelated activities and ensure the company is positioned to meet any new requirements; as well as develop ideas that enhances our companys competitive position for risk adjustment.
Principal Duties and Responsibilities:
Lead all internal and external riskadjusted projects.
Follows all CMS calls and presentations to ensure compliance and identify new ideas and strategies for improving risk adjustment.
Manages all vendor relationships and helps negotiate any new or existing contracts.
Develop and present complex analytics that communicate ongoing financial performance from internally custombuilt and externally vendorbuilt sources.
Communicate directly with the C Suite as needed for risk adjustment analytics.
Participate in all audits.
Develops strategies for provider training education and medical management.
Evaluates data quality of internal and external datasets.
Anticipates and meets or exceeds internal and/or external customer expectations and requirements; establishes and maintains effective relationships with customers and gains their trust and respect.
Hold self and others accountable to meet commitments.
Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise.
Build strong relationships and infrastructures that designate Mass General Brigham Health Plan as a peoplefirst organization.
Other duties as assigned with or without accommodation.
Qualifications
Education
- Bachelors degree required or the equivalent combination of training and experience plus four years of related experience; Masters degree preferred
Experience
- At least 35 years of Risk Adjustment experience
- At least 12 of Leadership experience preferred
- Previous experience leading complex projects and presenting analytics to executive level required.
- Knowledge of HHS Commercial Risk Adjustment and ACA CMS Risk Adjustment MassHealth risk adjustment and DxCG required.
- Medical coding certification or equivalent experience preferred.
- Previous experience with CMS risk adjustment audits (RADV) preferred.
Knowledge Skills and Abilities
- Deep understanding of healthcare regulations and guidelines related to risk adjustment including but not limited to the CMSHCC (Centers for Medicare and Medicaid Services Hierarchical Condition Categories) model and other relevant coding and documentation guidelines.
- Ability to analyze data and identify patterns or trends in patient diagnoses procedures and documentation that impact risk adjustment scores.
- Skill in working collaboratively with physicians coders and other healthcare professionals to improve clinical documentation and ensure accurate representation of patient conditions.
- Ability to analyze complex medical data identify discrepancies and make datadriven decisions to improve risk adjustment accuracy and compliance.
- Ability to lead and motivate teams manage projects and drive organizational change related to risk adjustment programs.
Additional Job Details (if applicable)
Working Conditions
- This is a remote role that can be done from most US states
- The role is Monday Friday with standard business hours in Eastern Time
Physical Requirements
- Standing Occasionally 333
- Walking Occasionally 333
- Sitting Constantly 67100
- Lifting Occasionally 333 20lbs 35lbs
- Carrying Occasionally 333 20lbs 35lbs
- Pushing Rarely (Less than 2
- Pulling Rarely (Less than 2
- Climbing Rarely (Less than 2
- Balancing Occasionally 333
- Stooping Occasionally 333
- Kneeling Rarely (Less than 2
- Crouching Rarely (Less than 2
- Crawling Rarely (Less than 2
- Reaching Occasionally 333
- Gross Manipulation (Handling) Constantly 67100
- Fine Manipulation (Fingering) Frequently 3466
- Feeling Constantly 67100
- Foot Use Rarely (Less than 2
- Vision Far Constantly 67100
- Vision Near Constantly 67100
- Talking Constantly 67100
- Hearing Constantly 67100
Remote Type
Work Location
Scheduled Weekly Hours
Employee Type
Work Shift
EEO Statement:
Mass General Brigham Competency Framework
At Mass General Brigham our competency framework defines what effective leadership looks like by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half PeopleFocused half PerformanceFocused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance make hiring decisions identify development needs mobilize employees across our system and establish a strong talent pipeline.
Required Experience:
Manager
Employment Type
Full-Time
