Vice President, Risk Adjustment
Company: VNS Health
Location: New York
Posted on: April 22, 2024
Job Description:
OverviewLeads the development, analysis and reporting of key
risk adjustment metrics, as well as oversees analyses of new
legislation and regulations regarding Risk Adjustment and assessing
the impact of any changes to the programs. Maximizes revenue
strategies for VNS Health Plans. Coordinates multiple cross
functional activities and projects related to risk adjustment
across all departments as well as interactions with external
vendors. Oversees the performance of the person(s) and vendors in
charge of chart audits, home visit assessments and the performance
of internal resources devoted to the Hierarchical Condition
Category/Risk Adjustment Factor (HCC/RAF) efforts. Collaborates
with the data science and business intelligence teams to determine
potential data analytics initiatives with the focus on improving
operations to improve risk score accuracy. Works under general
direction.Compensation:$193,600.00 - $258,200.00 AnnualWhat We
ProvideWhat We Provide
- Referral bonus opportunities
- Generous paid time off (PTO), starting at 30 days of paid time
off and 9 company holidays
- Health insurance plan for you and your loved ones, Medical,
Dental, Vision, Life and Disability
- Employer-matched retirement saving funds
- Personal and financial wellness programs
- Pre-tax flexible spending accounts (FSAs) for healthcare and
dependent care
- Generous tuition reimbursement for qualifying degrees
- Opportunities for professional growth and career
advancement
- Internal mobility, generous tuition reimbursement, CEU credits,
and advancement opportunities What You Will Do
- Leads various cross functional initiatives between VNS Health
Plans Services departments, including but not limited to Finance,
Service Ops, Medical Management, Business Intelligence, Provider
Relations, Compliance and Quality. Maintains relationships with
external vendors and provides ongoing support to manage initiatives
across Risk Adjustment.
- Builds strategies to create inhouse risk management initiatives
and capabilities thus reducing reliance on vendors and increasing
accuracy of data submissions.
- Develops and maintains risk adjustment performance management
dashboard, in partnership with Business Intelligence and Analytics
team.
- Develops and maintains an expert level of knowledge of Medicare
and risk-based reimbursement methodologies. Keeps up to date on
industry trends and writes reports on evolving payment policies.
Monitors CMS regulations related to risk score submissions and
reimbursement.
- Oversees overall coding strategy. Ensures vendor accountability
for performance and oversees chart review operations to close HCC
gaps.
- Oversees and verifies the submission of federal and state data
filings, report delivery to and from vendors and providers, and
ensures that data is transmitted completely, correctly, and on
time.
- Identifies and prioritizes risk adjustment opportunities and
identifies resources as needed.
- Develops and leads various initiatives for risk score
optimization. Assists reporting and analytics team in building
operational dashboards that can be used to monitor progress across
various initiatives.
- Collaborates with Quality Improvement (QI) department on Stars
and/or or other initiatives.
- Develops and audits Risk Assessment Data Validation (RADV)
readiness plan and monitoring program.
- Collaborates with internal and external experts to develop
metric-supported strategies that improve revenue and decrease risk
exposure.
- Leads the internal and external risk adjustment data
validations, including contingency planning.
- Performs all duties inherent in a senior managerial role.
Approves staff training, hiring, promotions, terminations, and
salary actions. Prepares and ensures adherence to the department
budget.
- Participates in special projects and performs other duties as
assigned.QualificationsEducation: Bachelor's Degree in Business
Administration, Finance, Health Care Administration, or other
related field requiredMaster's Degree in Business, Health
Administration, Health Policy or related discipline preferredWork
Experience:Minimum eight years of progressively responsible
experience in health insurance industry with specific experience in
risk adjustment requiredDemonstrated working knowledge of Medicare
Risk Adjustment methodology, Medicare payment policies, coding and
documentation practices, and process improvement and optimization
techniques requiredStrong understanding of healthcare
operations,encounter and risk adjustment data and the ability to
analyze, identify gaps and recommend strategic initiatives for
revenue maximization requiredOperational knowledge of provider
relations, claims, and medical management required
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Keywords: VNS Health, Jersey City , Vice President, Risk Adjustment, Executive , New York, New Jersey
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