Director Medicare and Medicaid Risk Adjustment

Mass General Brigham • Somerville, MA

4d • Remote

About The Position

Responsible for supporting programs through the end-to-end processes of data management and data submissions. This will be accomplished through designing, building and automating reporting analysis and modeling by utilizing a variety of systems.

Requirements

• Bachelor's Degree required (experience can be considered in lieu of a degree)
• 5+ years in a leadership role for Medicare Advantage and Medicaid risk adjustment is highly preferred
• 8-10+ years of experience in risk adjustment programs required
• At least 5-7 years of experience managing others is preferred
• Experience with predictive modeling software required.
• Subject Matter Expert on Medicare Advantage encounter data submissions
• Advanced SQL and or SAS programming skills required.
• Understanding of healthcare claims coding practices required
• Demonstrate Mass General Brigham Health Plan's core brand principles of always listening, challenging conventions, and providing value.
• Bring fresh ideas forward by listening to and working with employees and the people we serve.
• Respect the talent and unique contributions of every individual and treat all people in a fair and equitable manner.
• Strong, demonstrated track record of an ability to execute on time, on budget, and on scope.
• Strong aptitude for technology-based solutions.
• Ability to inject energy, when and where it’s needed.
• Current in healthcare trends.
• Demonstrated forward, visionary thinking; ability to see “what is” and envision “what could be.”
• Ability to develop, introduce, defend, and gain support for a new ideas and approaches.
• Excellent leadership skills and leadership track record.
• Ability to translate and communicate complex topics in a variety of forums, tailoring communications to effectively fit and influence the targeted audience, strong executive presence, presentation, and communication skills.
• Strong verbal, active listening, and written communication skills required.
• Ability to view the long-range trends and cycles of the business and industry and see the “big picture.”
• Ability to apply a variety of strategic frameworks to analyze problems and to guide and develop solutions.
• Ability to challenge the status quo and drive innovative thinking and the capability to successfully implement strategy.
• Excellent interpersonal skills, including the ability to influence others at all levels of an organization.
• Strong EQ; exercises self-awareness; monitors impact on others; is receptive to and seeks out feedback; uses self-discipline to adjust to feedback.
• Unquestionable integrity.

Nice To Haves

• Master's degree preferred
• Certified Risk Adjustment Coder (CRC) or the equivalent coding accreditation preferred

Responsibilities

• Perform analysis and reporting activities relating to: risk score calculation, claims/encounters data submission, chart review programs, audits, and related performance metrics.
• Participate in the development of requirements, testing and refinement of the underlying data and systems.
• Collaborate with other business units to deliver reports/updates on underlying data and systems as used by the Risk Adjustment team.
• Analyze data flow and data integrity to identify areas for improvement.
• Operate risk adjustment analytic vendor platforms to assist with intervention tracking, monitoring, analysis and reporting of diagnosis codes that drive risk score calculations.
• Work cross-functionally across multiple departments to design and develop financial dashboards, KPIs, and models to identify and track profit/loss and ROI trends.

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Number of Employees: 5,001-10,000 employees