Director, Risk Adjustment & Performance

COMPANY OVERVIEW

At Harbor Health, we are enhancing healthcare in Austin through strategic collaboration and innovative practices. We are looking for individuals to help us develop a member-focused experience that integrates comprehensive care with a modern payment model. If you are ready to contribute to a dynamic environment where your expertise is valued, we invite you to consider becoming a part of our team.

POSITION OVERVIEW

The Manager, Risk Adjustment drives process improvements and system enhancements and uses advanced knowledge of healthcare data, systems, and operational processes to serve as subject matter experts across multiple domains to support growth and improvement initiatives for encounters. Maintains expert level knowledge of regulatory requirements and business significance of encounters. At the direction of their leader, drives resolution of issues and oversees activities related to encounter submission performance optimization across multiple markets and states.

 

POSITION DUTIES & RESPONSIBILITIES

• Monitor overall team performance; project production, coding quality, and pace of projects observing industry standards, regulatory deadlines, business objectives.
• Collaborate and participate with multiple teams throughout the business to improve operations and promote business objectives.
• Create and conduct risk adjustment training for new hires and existing direct reports to improve performance, quality, and team efficiency
• Delegation, management, and ownership of risk adjustment project volumes and pace
• Evaluate a variety of medical records and provider documentation to ensure validity and accuracy of ICD-10- CM codes.
• Review project performance; identify and escalate coding and platform trends to management, manner to promote resolution and convey education.
• Align team performance following State and Federal regulatory guidance to ensure Risk Adjustment activities are compliant with all applicable laws, regulations, rules and policies.
• Support coding and auditing teams to meet our goals, CMS regulations and quality standards for Medicare Advantage and ACA Risk Adjustment, including provider education, coding, auditing and referrals along with the daily operations of the Risk Adjustment coders and auditors
• Support the review and delivery of provider audit results with education observing regulatory/accreditation/operational requirements.
• Compliance with all applicable laws and regulations
• Maximize health plan reimbursement by management of Risk solution vendors and products including attainment of SLAs.
• Hire, develop, and coach employees for results delivery.
• Detail-oriented, initiative-taking, and capable of working independently as well as part of a team.

DESIRED PROFESSIONAL SKILLS & EXPERIENCE

• Bachelor’s degree in a relevant field of study or commensurate work experience
• 5+ Years’ experience in RA Coding and Auditing