Manager, Medicare and Medicaid Risk Adjustment

Mass General Brigham•Somerville, MA

1d•$99,466 - $144,643•Remote

About The Position

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are at the forefront of transformation with one of the world’s leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage. Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills. We are pleased to offer competitive salaries and a benefits package with flexible work options, career growth opportunities, and much more. 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.

Requirements

Bachelor's Degree required; experience can be considered in lieu of a degree
At least 5-7 years of experience in managing risk adjustment programs in a healthcare setting, including direct team leadership, required
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.

Responsibilities

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.