AVP, Medicare Risk Adjustment Performance

🕒 Setembro 4

🇺🇸 Estados Unidos – Remoto (EUA)

💵 $198.219 - $297.329 / ano

⏰ Tempo Integral

🔴 Especialista

🎲 Riscos

👻 Score fantasma 18%

O que significa: quão provável esta vaga está aberta sem contratação ativa.Como ler: 60% ou mais significa que achamos que é uma vaga fantasma. Pontuações mais baixas preocupam menos.Como pontuamos: tempo em aberto, republicações, vagas abertas vs tamanho do time, rapidez para fechar vagas, e se o salário está divulgado.Observação: é uma estimativa de dados públicos, não um julgamento da empresa. Vagas reais podem ter pontuação alta, então use como uma dica, não como um fato.

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Alignment Health

SiteLinkedInTodas as Vagas

501 - 1000 funcionários

Fundada em 2013

⚕️ Seguro de Saúde

🛡️ Seguros

🏥 Saúde

💰 $135.000.000 Series C em 2020-03

Healthcare Insurance • Insurance • Healthcare

Alignment Health está comprometida em fornecer cuidados abrangentes para membros do Medicare, enfatizando as necessidades dos idosos, dos cronicamente doentes e daqueles que são frágeis. Com a missão de transformar a saúde dos idosos, a Alignment Health utiliza um modelo de atenção personalizado e tecnologia avançada para oferecer serviços de saúde de alta qualidade e baixo custo. Sua equipe de atendimento de concierge 24 horas por dia, 7 dias por semana, colabora com provedores locais confiáveis para garantir que cada membro receba um atendimento personalizado, refletindo o compromisso da empresa em tratar todos os membros como membros valiosos da família.

Descrição

• Provide executive leadership for Alignment Health’s enterprise Medicare Risk Adjustment performance strategy and operations • Own annual RAF performance objectives and Risk Adjustment targets • Lead prospective, concurrent and retrospective Risk Adjustment strategies and execution • Oversee provider engagement, coding operations, chart retrieval, submission, analytics, vendor management and revenue realization • Partner with Market Operations, Network Management, Clinical Operations, Finance, Compliance, and Data & Technology teams • Lead the annual operating plan, including goals, measures, milestones, resources and market-level execution plans • Establish performance guidelines for quality, productivity, service levels and financial outcomes • Use analytics and strategic business analysis to identify opportunities, risks, root causes and interventions • Partner with Finance and Actuarial teams on RAF forecasting, revenue implications, bid development and long-range planning • Establish strategic direction and performance expectations for Risk Adjustment vendors and external partners • Serve as executive sponsor for provider coding performance and documentation improvement initiatives • Develop scalable reporting, analytical and operational capabilities supporting visibility, audit readiness and reduced manual controls • Define business requirements for workflow modernization, automation, provider enablement and enterprise reporting • Sponsor technology initiatives improving scalability, productivity, transparency and audit readiness • Support RADV readiness, validation findings, reconciliation, diagnosis corrections and audit remediation • Establish policies, procedures, standard work and governance routines for accurate and compliant execution • Maintain knowledge of CMS risk adjustment requirements, model changes and regulatory guidance • Build, mentor and retain a high-performing multidisciplinary team • Develop multi-year strategies, annual goals, KPIs and resource requirements • Lead business cases for Risk Adjustment investments, operational initiatives and technology capabilities • Oversee assigned leaders and staff, including workforce planning, recruiting, training, goal setting, performance management and coaching

🎯 Requisitos

• Ten or more years of progressive experience in managed care, Medicare Advantage, healthcare analytics, healthcare finance, risk adjustment, population health or related operations • Experience leading enterprise Risk Adjustment programs across multiple markets and provider arrangements • Demonstrated responsibility for financial performance, forecasting, strategic planning, or major business initiatives • Proven track record managing executive stakeholders and enterprise-wide programs • Seven or more years of people leadership, including development of high-performing analytical or operational teams • Bachelor’s degree in healthcare, business, finance, analytics, information systems or a related field, or equivalent relevant experience • Demonstrated knowledge of CMS-HCC risk adjustment methodology, Medicare Advantage reimbursement, coding and documentation programs, encounter data, and performance measurement • Demonstrated experience designing or leading analytics, reporting, data governance or scalable data infrastructure that supports reporting accuracy, regulatory compliance and audit readiness • Experience leading complex cross-functional initiatives and working with executives, providers, vendors, compliance partners and technical teams • Experience with risk adjustment forecasting, provider performance analytics, data warehousing, SQL-based analytics or business intelligence platforms • Experience supporting multiple government-program lines of business or large, multi-market Medicare Advantage operations • Advanced ability to translate complex data into executive-level insights, recommendations and action plans • Strong verbal, written, presentation, organization and relationship-management skills • Must be efficient in Excel; SQL knowledge preferred • Good organization, analytical, interpersonal and communication skills

🏖️ Benefícios

• Equal Opportunity/Affirmative Action Employer