Quality Performance & Initiatives, Leader, Risk Adjustment Analytics #913
Status: Full-time, Exempt
MVP’s Quality and Clinical Analytics department has the responsibility of maximizing reimbursement for multiple lines of business including Medicare, Medicaid, and the commercial exchange. Risk Adjustment is utilized to align risk score and payment of healthcare costs to ensure members with higher clinical need have appropriate dollars to cover healthcare costs. The Leader, Risk Adjustment Analytics will work with a team of analysts to target members with risk gaps to maximize payment. The Leader, Risk Adjustment Analytics will report to the Vice President, Quality and Clinical Analytics and will be the analytic lead to improve risk-adjusted revenue.
- Lead a team of analysts skilled in the various risk-adjustment systems currently in use by NY State and CMS.
- Work with the Risk Adjustment Team on both retrospective and prospective interventions.
- Supply Risk Adjustment Team with retrospective chart chase lists.
- Work with vendors in targeting chart review and maximizing revenue.
- Provide targeting and refinement for prospective risk adjustment efforts.
- Supporting development and execution of a multi-year improvement strategy and annual plan of action to maximize reimbursement.
- Working with field teams to develop and execute a provider engagement strategy in support of closing Quality and Risk gaps with key strategic partners.
- Driving the development of targeted performance data and distribution efforts, both internally and externally to provider partners.
A key component of this role is demonstrating a passion about transforming our healthcare system for those who need it most. The role requires frequent cross departmental collaborations and conducting briefings. This position will require significant creativity, organization, motivation, and attention to detail.
Bachelor’s Degree in Business Administration, Analytics or Health Sciences/Services related degree strongly preferred. Candidates who possess an Associate’s degree with the equivalent combination of related experience may also be considered.
2 years’ experience in risk adjustment payment models required.
Demonstrated experience managing multiple projects at once while achieving desired results required.
3 – 5 years’ experience in healthcare or managed care industry preferred.
- Possess strong planning skills with the ability to effectively prioritize of tasks, projects, etc. in a dynamic environment.
- Possess strong analytical skills with detailed knowledge of healthcare operations and datasets.
- Keen attention to detail.
- Strong customer service orientation.
- Interpersonal skills (e.g., partnering, conflict management, mentoring), with strong verbal and written communication skills, and the ability to interact with most levels of business, technical and end users.
- Team oriented: Comfortable working in a team environment as well as independently and possess a sense of accountability and urgency in completing assignments.
- Knowledge of CMS risk adjustment and reinsurance payment processes and audits for Medicare programs.
- Knowledge of revenue and data issues relating to CMS and NYS encounter submissions.
MVP Health Care is a nationally recognized, not-for-profit health insurer caring for more than 700,000 members in New York and Vermont. Committed to the complete well-being of our members and the communities we serve, MVP makes health insurance more convenient, more supportive, and more personal. We are powered by the ideas and energy of more than 1,700 diverse, employees from all backgrounds, committed to having a positive impact on the health and wellness of everyone we serve. MVP Health Care is an Affirmative Action/ Equal Employment Opportunity (PDF). We recruit, employ, train, compensate, and promote without regard to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, disability, genetic information, veteran status, or any other basis, e.g., Pay Transparency (PDF), and the EEO is the Law Poster and Supplement protected by applicable federal, state or local law. Any person with a disability needing special accommodations to the application process, please contact Human Resources at firstname.lastname@example.org
Please apply and learn more – including how you may become a proud member of our team.