Director of Risk Adjustment and Coding Operations
Holy Cross

Job Info

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Employment Type:Full timeShift:

Description:
**Must live in the South Florida area - this is not a remote position**

Roles and Responsibilities

• Oversee, coordinate, or perform data mining and data-driven analysis to forecast/evaluate the performance of the risk adjustment program and refine annual risk adjustment program strategies to achieve optimal performance. Incorporate data-driven analysis into the risk adjustment processes.
• Develop and monitor metrics of program success.
• Oversight of vendor relationships to drive program success (analytics, practice management).
• Oversight of client contractual requirements and deliverables.
• Development and monitoring of provider scheduling and prioritization.
• Identification and development of training opportunities to drive success.
• Identification and development of process improvement.
• Measurement and presentation of financial impact to executive leadership.
• Working across matrixed organization to drive results.
• Establishes operating policies and procedures for all risk adjustment programs and processes in coordination with internal and external operational units.
• Represent the organization in dealing with vendors, delegated entities, providers and the Centers for Medicare and Medicaid Services (CMS).
• Determining resource needs to support incremental functionality required for government products; contributes to budget, and acquires resources accordingly.
• Develops and maintains relationships with key medical leaders

Education & Qualifications

• South Florida area candidates or candidates willing to relocate
• Bachelor's degree from a four-year college required
• RHIA/RHIT required credentials preferred
• Specialization in building business units to become more effective and efficient while fostering a team environment
• 7+ years' experience working in a value-based provider group, health plan, and/or vendor contracting with health plans providing annual wellness/risk adjustment services
• 5+ years' experience in a leadership role in a capacity developing and implementing risk adjustment, coding, wellness assessment, and analytics programs and processes
• Expertise in Medicare programs and regulations including fraud and abuse and Medicare Hierarchical Condition Coding Risk Adjustment
• Excellent analysis and presentation skills
• Experience working in high-growth environment preferred
• Valid driver's license

Our Commitment to Diversity and Inclusion

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.

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