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Point32Health · 2 months ago

Manager, Risk Adjustment Operations and Provider Consulting

Canton, MA

Full-time

Onsite

Senior Level

$109K/yr - $164K/yr

6+ years exp

Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. The Manager will lead the Risk Adjustment Operations & Provider Consulting team, focusing on program management, provider engagement, and consultation activities to ensure accurate capture of risk adjustment data across various member markets.

Health CareInsurance

Responsibilities

• Provider Consulting, Risk Score Reporting and Collaboration: The Manager will oversee all provider engagement and reporting activities for risk adjustment programs and initiatives that impact Medicare, Medicaid, and Duals product members. This individual will lead the development and implementation of provider-specific analyses and engagement plans, and design effective risk adjustment optimization strategies for the markets we serve. This individual will oversee the analysis, interpretation and synthesis of medical group specific results and risk score trend information; develop dashboard reporting and a regular schedule for delivering the results of standard (and ad hoc) analyses to improve awareness and understanding of risk adjustment results and the quality, accuracy and identification of member health conditions. The Manager will build relationships and drive risk adjustment engagement with senior leaders at contracted provider organizations

• Risk Adjustment Program Management and Vendor Evaluation: The Manager will be responsible for risk adjustment program management and key supporting functions including the development, implementation and ongoing management of contracts that require the highest levels of service delivery from external vendors. This individual will regularly review the effectiveness of programs, processes, infrastructure and reporting to identify improvement opportunities and recommend changes to improve program results and effectiveness. The Manager will collaborate with key internal stakeholders (Clinical, Contracting, Provider Partnerships, Actuarial, Procurement and Compliance) to refine prospective and retrospective diagnosis coding programs. This individual will oversee team efforts to assess additional program opportunities that can be procured or potentially developed internally; and take a leadership role in collaboration with Procurement during contract negotiations. The Manager will frequently present upon the effectiveness of risk adjustment initiatives and programs to both internal senior leaders and external stakeholders

• Strategy Development and Project Management: The Manager will support department leadership in strategic planning efforts and annual risk adjustment business plan development. They will drive execution against that business plan while optimizing collaboration between Risk Adjustment and other departments or areas that are external facing such as Contracting, Actuarial, Procurement, Provider Partnerships and Care Management / Clinical Affairs. The Manager will oversee the team’s project management efforts including monitoring and evaluating progress against timelines, project milestones and key deliverables. This individual will utilize performance analysis methods to identify and recommend opportunities for process improvement across the department. The Manager will also help lead the current-state assessments of provider organizations’ risk adjustment capabilities in new markets or regions

• Revenue Tracking and Financial Reporting: The Manager will support department leadership by collaborating across business divisions and functions to coordinate the development and refinement of financial dashboards and reporting that identify and track revenue trends and program results for Medicare, Medicaid, Duals and or Commercial small and individual group market membership. The Manager will collaborate with Actuarial and analytical teams within the department to understand and monitor the financial impact of risk adjustment programs

• General Management: The Manager will lead a team of six peoples (three risk adjustment consultants and three program management professionals)

• Other duties and projects as assigned

Qualification

Risk Adjustment Program ManagementProvider Engagement StrategiesAnalytical SkillsProject ManagementProcess ImprovementLeadership SkillsCommunication SkillsFinancial Data AnalysisDetail-orientedTeam PlayerCritical Thinking

Required

Bachelor's degree required

Minimum six years in a progressively responsible role with leadership experience in a complex operational setting or consulting role

Previous experience working in strategy development and implementation, analytical and process improvement in the health care / health plan sector or management consultancy

Experience working with CMS, state agencies, health insurers, medical provider systems and/or risk adjustment desired

Highly organized, self-motivated, detail-oriented, and energetic team player who can also work independently

Analytical thinker with strong consultative skills

Working knowledge of both the medical and business side of health plan and provider operations

Ability to understand and navigate complexity and regulation

Strong leadership skills with proven ability to lead change to accommodate evolving organizational and regulatory processes

Strong communication, influencing and partnering skills at all organizational levels across internal functions and with business and medical leadership at physician organizations

Strong one on one, small group and large group communication skills

Excellent judgment, critical thinking, and decision-making abilities

Strong process management and project management skills

Ability to work with data (including financial data) to identify trends and identify process improvements