Manager, Risk Adjustment Operations

Iora Health   •  

Boston, MA

Industry: Hospitals & Medical Centers

  •  

Less than 5 years

Posted 59 days ago

This job is no longer available.

The Manager will work closely with the VP for Medicare Risk Operations, other business and clinical leaders to develop and implement comprehensive strategies to manage and drive improvement in our end-to-end clinical documentation process, from eligibility and on-boarding to claims submission and reporting. You will work cross-functionally with our clinical and technical teams to develop the tools, processes and reporting required to ensure compliance with a complete and accurate coding and billing function.

This role reports into the VP of Medicare Risk Operations and will be located in Boston, MA.

Responsibilities:

  • Development and support of Iora's Network strategies
  • Work with market leaders to identify opportunities and implement best practices
  • Evaluate and build the business case for strategic partnerships that expand our leverage upstream or downstream of typical primary care.
  • Performance analysis and feedback
  • Work with analytics, finance and market leadership teams to
  • design actionable, accurate performance reporting that reflects key process and outcome measures.
  • develop and support forums for review of Risk Adjustment key metrics with front line care teams and managers.
  • Program Management and Implementation
  • Track overall portfolio of MRO projects/initiatives and integration with other key functional teams' work plans.
  • Serve as a subject matter expert within the company on MRO strategy, tools and processes.
  • Work with market leaders to implement company-wide MRO initiatives or strategic programs and to inform the priorities of Iora's clinical and EHR design teams.
  • Work with Financial Planning and Analysis to track and evaluate the impact of initiatives and programs.
  • Work with VP for Medicare Risk Operations, CFO and Medical Director to build quarterly and annual plans for the MRO function.

Qualifications

  • Bachelor's degree in business, health administration, health policy, finance or a related field is required. Master's degree preferred
  • 3-5 years of experience in Medicare Risk Adjustment
  • 2+ years of people management experience required
  • Experience working across sectors, in a fast-growth, fast-paced environment, and/or in a highly complex, matrixed organization.
  • Excellent organizational, project and program management skills; experience leading change and implementing programs
  • Strong quantitative and analytical skills
  • Demonstrated ability to be an effective, collaborative partner with internal and external stakeholders
  • Excellent written and verbal communication skills
  • Claims processing experience preferred
  • This role requires 10-15% travel