Facility Maintenance Supervisor
The Director, Risk Adjustment will lead the risk adjustment program at Boston Medical Center Health System. In this role, the Director will be responsible for developing a multi-product risk adjustment strategy aimed at ensuring accurate risk coding for all BMCHP members. Joining BMCHS means joining a health system with a diverse landscape of risk adjustment activities, covering multiple different product types and spanning both the payor and provider space. BMCHP products include: Medicaid Managed care programs in both Massachusetts and New Hampshire, a commercial ACA plan, a duals plan, and a Medicaid ACO program. The Director will be responsible for building out core health plan-based risk adjustment operations, as well as developing innovative provider-based programs, and other product-specific risk adjustment strategies. Success will require competence in risk adjustment strategy, an ability to build and scale risk adjustment programs, and an ability to partner effectively with provider groups to design and implement point care risk adjustment interventions.
KEY FUNCTIONS/RESPONSIBILITIES:
OVERALL RISK ADJUSTMENT STRATEGY: Responsible for engaging stakeholders across the Health System (Providers, IT, Finance, Revenue cycle, etc) to define a system strategy for risk adjustment, including strategies for provider engagement, IT system capabilities, revenue cycle operations, etc
RISK ADJUSTMENT ANALYTICS: Partner with Clinical and Financial Analytics teams to define opportunities and areas of focus to optimize risk adjustment performance across all products
OVERALL RISK ADJUSTMENT PERFORMANCE MANAGEMENT: Develops and maintains risk adjustment performance management and reporting dashboard, in partnership with Clinical and Financial Analytics leaders
GOVERNMENT AND REGULATORY TRACKING: In-house expert on risk adjustment models; maintains current view of risk adjustment regulatory changes and product-specific risk model changes; ensures appropriate BMCHP operational responses to regulatory and risk adjustment program changes
OPERATIONAL OVERSIGHT: Direct supervisory responsibility for Boston Medical Center Health System Coding Validation team and Risk Adjustment program management team
CONTRACT MANAGEMENT: Oversee overall vendor strategy for coding; manage various Health System contracts for coding services; ensure vendor accountability for performance
PROVIDER SITE ENGAGEMENT AND PARTNERSHIPS: Partner with provider account teams to communicate risk adjustment strategies and initiatives to provider groups; partner with provider groups to implement risk adjustment initiatives
INTERNAL STAKEHOLDER MANAGEMENT: Ensures open communication and collaboration across all relevant internal departments/positions that intersect with risk adjustment team (Quality, Pricing, Provider Relations, Product teams, etc)
Specific tasks may include design and implementation of the following:
Other duties as assigned
QUALIFICATIONS:
EDUCATION:
EXPERIENCE REQUIRED:
PREFERRED/DESIRABLE:
COMPETENCIES, SKILLS, AND ATTRIBUTES:
*Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status.
Required Skills Required Experience