Director Medicare and Medicaid Risk Adjustment

Title: Director Medicare and Medicaid Risk Adjustment

Location: Remote United States

Full time

Job Description:

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.

Qualifications

Education

• Bachelor's Degree required (experience can be considered in lieu of a degree)
• Master's 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 Plan's 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 it's 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.

Additional Job Details (if applicable)

Working Conditions

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

Remote Type

Remote

Work Location

399 Revolution Drive

Scheduled Weekly Hours

40

Employee Type

Regular

Work Shift

Day (United States of America)

Pay Range

$144,206.40 - $209,757.60/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 package. In 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.