Senior Manager, Risk Stratification, Remote

Primary Duties:

• Lead or coach process owners and improvement teams in optimizing accurate coding, billing, documentation. Acting as the liaison for multiple teams in a matrixed environment. This includes collaboration with clinical, market teams and compliance/legal.
• Responsible for risk payer relationships. They will eventually lead the team who is responsible for tracking all diagnosis submissions through the entire risk process and our overall workflow.
• Work with payer to promote risk programs.
• Own reporting for meetings with payer leaders for our working groups related to work with Risk.
• Oversee development for reporting for all stages of the risk adjustment process.
• Work with BI and Impact Analytics to determine impact of various interventions.
• Serve as a key Business Stakeholder and RA subject matter expert for the BI and Analytics team.
• Act as the liaison with the analytics team to discuss risk trends the team has observed; understand patterns and assist with analytical interpretation.
• Collaborate and support the performance team with operational execution.
• Develop strategies and tactics to improve risk adjustment accuracy through technology/product and program enhancements.
• Work with internal and external stakeholders on projects and programs.

Minimum Qualifications:

• Bachelor’s degree in Healthcare Adm or Business (or appropriate equivalent training)
• 5+ years payer/healthplan/value based care company including Medicare and Commercial
• 5 + years risk adjustment including Medicare, MSSP
• Demonstrated knowledge and experience with risk adjustment methodologies such as HCC, 3M, Milliman, etc.
• 5+ years of program management, project leadership and execution experience in a healthcare or product related setting.
• 5+ years of management experience
• Strong data analytics skills
• Proficiency in Microsoft Office, Project/Product management, Google Suite

Preferred:

• MBA, MHA or other Master’s level training in health, business or IT
• 5+ years of program management, project leadership and execution experience in a healthcare or product related setting.
• Demonstrated leadership ability in prior workplace, including running teams and managing high import portfolio, with internally and externally facing representation responsibilities
• Advanced Microsoft Office, Project/Product manage, Analytics: SQL, PowerBI, SAS