Director Medicare and Medicaid Risk Adjustment

Site: Mass General Brigham Health Plan Holding Company Inc.

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 not-for-profit we support patient care research teaching and community service striving to provide exceptional care. We believe that high-performing 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

Responsible for supporting programs through the end-to-end processes of data management and data submissions. This will be accomplished through designing building and automating reporting analysis and modeling by utilizing a variety of systems.

Essential Functions
-Perform analysis and reporting activities relating to: risk score calculation claims/encounters data submission chart review programs audits and related performance metrics.
-Participate in the development of requirements testing and refinement of the underlying data and systems.
-Collaborate with other business units to deliver reports/updates on underlying data and systems as used by the Risk Adjustment team.
-Analyze data flow and data integrity to identify areas for improvement.
-Operate risk adjustment analytic vendor platforms to assist with intervention tracking monitoring analysis and reporting of diagnosis codes that drive risk score calculations.
-Work cross-functionally across multiple departments to design and develop financial dashboards KPIs and models to identify and track profit/loss and ROI trends.

Education

• Bachelors Degree required (experience can be considered in lieu of a degree)
• Masters degree preferred

Licensure

• Certified Risk Adjustment Coder (CRC) or the equivalent coding accreditation preferred

Experience

• 5 years in a leadership role for Medicare Advantage and Medicaid risk adjustment is highly preferred
• 8-10 years of experience in risk adjustment programs required
• At least 5-7 years of experience managing others is preferred

Knowledge Skills and Abilities

• Experience with predictive modeling software required.
• Subject Matter Expert on Medicare Advantage encounter data submissions
• Advanced SQL and or SAS programming skills required.
• Understanding of healthcare claims coding practices required

• Demonstrate Mass General Brigham Health Plans core brand principles of always listening challenging conventions and providing value.
• Bring fresh ideas forward by listening to and working with employees and the people we serve.
• Respect the talent and unique contributions of every individual and treat all people in a fair and equitable manner.
• Strong demonstrated track record of an ability to execute on time on budget and on scope.
• Strong aptitude for technology-based solutions.
• Ability to inject energy when and where its needed.
• Current in healthcare trends.
• Demonstrated forward visionary thinking; ability to see what is and envision what could be.
• Ability to develop introduce defend and gain support for a new ideas and approaches.
• Excellent leadership skills and leadership track record.
• Ability to translate and communicate complex topics in a variety of forums tailoring communications to effectively fit and influence the targeted audience strong executive presence presentation and communication skills. Strong verbal active listening and written communication skills required.
• Ability to view the long-range trends and cycles of the business and industry and see the big picture.
• Ability to apply a variety of strategic frameworks to analyze problems and to guide and develop solutions.
• Ability to challenge the status quo and drive innovative thinking and the capability to successfully implement strategy.
• Excellent interpersonal skills including the ability to influence others at all levels of an organization.
• Strong EQ; exercises self-awareness; monitors impact on others; is receptive to and seeks out feedback; uses self-discipline to adjust to feedback.
• Unquestionable integrity.

Working Conditions

• This is a remote role that can be done from most US states

Remote

399 Revolution Drive

40

Regular

Day (United States of America)

Pay Range

$144206.40 - $209757.60/Annual

Grade

9

At Mass General Brigham we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive and any offer extended will take into account your skills relevant experience if applicable education certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however it does not encompass all elements contributing to your total compensation addition to competitive base pay we offer comprehensive benefits career advancement opportunities differentials premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.

8925 Mass General Brigham Health Plan Holding Company Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race color religious creed national origin sex age gender identity disability sexual orientation military service genetic information and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process to perform essential job functions and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973 the Vietnam Veterans Readjustment Act of 1974 and Title I of the Americans with Disabilities Act of 1990 applicants who require accommodation in the job application process may contact Human Resources at .

Mass General Brigham Competency Framework