Site: Mass General Brigham Health Plan Holding Company, Inc.
Responsible for overseeing and managing the risk adjustment program for Medicare and Medicaid within MGB Health Plan. This role leads and develops a team, collaborates with cross-functional teams to optimize risk adjustment strategy and operations, and ensures accurate documentation and coding of patient conditions.
Essential Functions
-Lead risk adjustment strategy and operations.
-Directly manage and develop a team (including hiring, performance management, and coaching).
-Develop and present analytics that communicate ongoing financial performance.
-Lead risk adjustment operational work across the entire lifecycle of the payment process.
-Develop content and strategies for provider training, education, and medical management.
-Evaluates data quality of internal and external datasets.
-Work with vendors to help negotiate new or existing contracts.
QualificationsEducation- Bachelor's Degree required; experience can be considered in lieu of a degree
Experience- At least 5-7 years of experience in managing risk adjustment programs in a healthcare setting, including direct team leadership, required
Knowledge, Skills, and Abilities- In-depth knowledge of risk adjustment methodologies and healthcare coding guidelines for Medicare and Medicaid lines of business.
- Familiarity with healthcare regulations and compliance requirements related to risk adjustment.
- Strong analytical and problem-solving skills.
- Excellent communication skills to collaborate effectively with various stakeholders.
- Proven ability to manage, coach, and develop direct reports.
- Strong problem-solving skills to address coding and documentation challenges and develop corrective action.
Additional Job Details (if applicable)Working Conditions- This is a remote role that can be done from most US states with a strong preference for local candidates who could attend occassional in-person meetings
- This is a Monday-Friday role with standard business hours (in Eastern time)
Remote TypeRemote
Work Location399 Revolution Drive
Scheduled Weekly Hours40
Employee TypeRegular
Work ShiftDay (United States of America)
Pay Range$99,465.60 - $144,643.20/Annual
Grade8
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.
Mass General Brigham Competency FrameworkAt Mass General Brigham, our competency framework defines what effective leadership "looks like" by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.
