The Vice President of HCC Risk Adjustment is responsible for the oversight of risk adjustment and coding, and establishing and managing company coding guidelines, policy and procedures. The VP plays a critical role in the development and execution of business strategy and compliance, overseeing the development, implementation and execution of Medicare advantage and Managed Medicaid risk adjustment strategy.
- Planning and execution of the Risk adjustment coding business including ACA/Exchange, Medicare Advantage, and Medicaid plans.
- Demonstrate and pass on expert knowledge in HCC risk adjustment methodologies and industry-leading solutions and strategies to drive optimized results.
- Partner with Analytics to develop new predictive, analytic and reporting tools to glean actionable insights into current performance and new opportunities and leverage a network of experts - internal and external - to enhance Risk Adjustment innovation and performance.
- Monitor risk adjustment submissions as compared to expected revenue and proactively address gaps in data submissions and impacts to forecasting and budgets.
- Improve monitoring and auditing protocols to ensure internal and vendor compliance with all applicable regulations and risk adjustment data validation audits (RADV).
- Leverage market insights to monitor trends and external landscape, and to inform capability strategies and customer use case scenarios.
- Consult with and support Payer Client Services team with all Risk Adjustment programs and initiatives.
- Ensure operational integration of contractual requirements resulting in adherence to quality standards and performance expectations as required and strive to exceed established service level agreements.
- Oversight of the Coding management team and staff in all departmental functions including implementing best practices in talent acquisition for HCC coders, overseeing onboarding, staffing plans and staff performance to ensure optimal talent management and utilization.
- Develop and manage a multi-million dollar department budget.
- Minimum of a Bachelor's degree in business, finance, analytics, healthcare delivery, public policy or a related field is required. A Master's degree in a related field of study is preferred.
- Ten (10) or more years' experience in the managed care industry or related field required.
- Five (5) or more years' experience in Medicare Advantage, Commercial, or related healthcare coding and risk adjustment is required. Risk Adjustment experience - expert status expected
- AAPC or AHIMA certification preferred.
- Strong analytical skills needed to prepare and analyze data to drive KPIs and process improvements within the department.
- Strong communication skills; ability to present information in a concise manner to multiple organizational levels including Board of Directors
- Must be able to travel a minimum of 50% of the time (more travel may be required at times).