Director, Risk Adjustment & Performance

COMPANY OVERVIEW

At Harbor Health, we are enhancing healthcare in Austin through strategic collaboration and innovative practices. We are looking for individuals to help us develop a member-focused experience that integrates comprehensive care with a modern payment model. If you are ready to contribute to a dynamic environment where your expertise is valued, we invite you to consider becoming a part of our team.

POSITION OVERVIEW

The Manager, Risk Adjustment drives process improvements and system enhancements and uses advanced knowledge of healthcare data, systems, and operational processes to serve as subject matter experts across multiple domains to support growth and improvement initiatives for encounters. Maintains expert level knowledge of regulatory requirements and business significance of encounters. At the direction of their leader, drives resolution of issues and oversees activities related to encounter submission performance optimization across multiple markets and states.

 

POSITION DUTIES & RESPONSIBILITIES

• Monitor overall team performance; project production, coding quality, and pace of projects observing industry standards, regulatory deadlines, business objectives.
• Collaborate and participate with multiple teams throughout the business to improve operations and promote business objectives.
• Create and conduct risk adjustment training for new hires and existing direct reports to improve performance, quality, and team efficiency
• Delegation, management, and ownership of risk adjustment project volumes and pace
• Evaluate a variety of medical records and provider documentation to ensure validity and accuracy of ICD-10- CM codes.
• Review project performance; identify and escalate coding and platform trends to management, manner to promote resolution and convey education.
• Align team performance following State and Federal regulatory guidance to ensure Risk Adjustment activities are compliant with all applicable laws, regulations, rules and policies.
• Support coding and auditing teams to meet our goals, CMS regulations and quality standards for Medicare Advantage and ACA Risk Adjustment, including provider education, coding, auditing and referrals along with the daily operations of the Risk Adjustment coders and auditors
• Support the review and delivery of provider audit results with education observing regulatory/accreditation/operational requirements.
• Compliance with all applicable laws and regulations
• Maximize health plan reimbursement by management of Risk solution vendors and products including attainment of SLAs.
• Hire, develop, and coach employees for results delivery.
• Detail-oriented, initiative-taking, and capable of working independently as well as part of a team.

DESIRED PROFESSIONAL SKILLS & EXPERIENCE

• Bachelor’s degree in a relevant field of study or commensurate work experience
• 5+ Years’ experience in RA Coding and Auditing
• 2+ Years’ experience managing teams
• 4+ Years’ experience as the subject matter expert in areas of Commercial (ACA) Risk Adjustment
• 2+ Years Experience with Electronic Health Records (EHRs) and Clinical Continuity of Care Documents (CCDs)
• Certified Professional Coder (CPC)
• 3+ Years’ experience in leading the Risk/Encounter submission process
• Partner with our business leaders to design and implement business metrics and dashboards, with the highest standards of analytical rigor and data integrity
• Familiarity with Texas Department of Insurance (TDI) rules, regulations, and law preferred
• Experience in the Start Up phase of a health plan is preferred
• Strong Excel and PowerPoint background
• Experience in developing test cases
• Background in vendor implementations

WHAT WE OFFER

• Opportunity to shape, develop and mentor individuals to grow their career and impact their lives.
• Collaborative and dynamic work environment
• An organization made up of people who are passionate about changing the healthcare landscape.
• Competitive salary and benefits package
• Professional development and growth opportunities
• A transparent and unique culture

Harbor Health is an Equal Opportunity Employer. We do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other characteristic protected by law. We are committed to creating an inclusive environment for all clinicians and teammates and actively encourage applications from people of all backgrounds.