VP of Risk Adjustment

  • 38050
  • Health - Actuarial
  • |
  • New York, United States
  • |
  • Aug 25, 2020
Insurance
RESPONSIBILITIES
  • Responsible for project planning, management and execution of key initiatives and projects.
  • Responsible for the development of new scopes of work and refinement of existing scopes of work to assure they meet company’s current needs.
  • Provides guidance and information, when requested, as an internal resource.
  • Provide industry guidance to staff within the Risk Adjustment and Coding Department.
  • Ensure skill sets of staff are up-to-date and at the highest level of industry standards.
  • Serves as the strategic leader accountable for utilizing analytics coupled with clinical technology to maximize growth and drive continuous improvement in appropriate documentation and coding.
  • Oversees physician education and engagement strategy and execution for risk adjustment; and national and market-based coding, and related vendor relationships.
  • Drives technological advancement; Oversees the development and execution of risk adjustment programs that ensure timely and accurate assessment and reporting of chronic conditions.
  • Ensures that staff collaborates with medical leadership, market leaders, and utilization management leaders to stay current with market trends/needs.
QUALIFICATIONS
  • A Master’s degree in Business Administration, Public Health or Healthcare Administration preferred.
  • Strong business fundamentals and prior experience in Health Services are a requirement. Individual will have proven leadership capabilities, executive presence, outstanding communication skills and be proficient at driving change.
  • 7 years leadership experience at a senior level, preferably with a large organization and multi-site locations.
  • Experience in a complex healthcare delivery environment, including risk assessment and revenue optimization.
  • Significant experience setting strategy for Risk Assessment, Medical Coding, and designing models for effective improvement of proper documentation and coding of clinical diagnoses.
  • Possess a proven track record of leading high performing teams and developing new product/service offerings.
  • Excellent leadership skills including ability to think strategically, develop vision, and execute for results.
  • Proven ability to innovate and drive large organization change.
  • Experience working in a large highly matrixed organization, with proven ability to develop internal enterprise relations, and external relationships.
  • Excellent presentation and communication skills.
  • Strong business and financial background with a sense of urgency and a desire to achieve top line results in a fully appropriate and compliant manner.
  • Demonstrated experience in risk assessment and revenue optimization achieved through informatics and analytic data.
  • Strong knowledge of Medicare and Medicaid Risk Adjustment, including technical requirements as well as challenges health plans and providers may have in meeting reporting requirements.
  • Understanding of applicable CMS Medicare Part C & D reporting requirements including manuals, review guides and Code of Federal Regulations.
  • Ability to interact with internal and external customers at all management levels.
  • Project management and/or consulting experience a plus.
  • Strong problem solving ability and a customer centric focus.
  • Be team focused with an attitude of group achievement as the primary goal.
  • Highly organized with a strong attention to detail.
  • Demonstrated leadership and management skills.
  • Effective collaboration skills and experience.
  • MS Office proficiency.
  • Strong oral and written communication skills, including presentation skills.
  • Ability to work in a virtual office and virtual teaming experience.