Assistant Director of Risk Adjustment

AgeWell New York is seeking a&nbsp;<strong>Full Time Assistant Director of Risk Adjustment&nbsp;</strong>to join its team of professionals at our offices in Lake Success, NY. Conveniently located on the Queens/Long Island border,&nbsp;<strong>AgeWell New York&nbsp;</strong>is a&nbsp;managed care plan with diverse product lines rooted in the communities and culture of the New York metropolitan area.

Lake Success, NY

AgeWell New York

<h1>Join the AgeWell New York Team</h1> <p>We offer competitive salaries, excellent benefit packages and the opportunity to work and exchange ideas with leaders in their fields of specialization. We work in a friendly, collaborative environment with exciting career-ladder opportunities.</p>

keywords: risk management,teamwork,benefits,risk adjustment,support,analysis,education,experience,software development,knowledge,degree

Experienced Full-time

Overview: The Assistant Director of Risk Adjustment is responsible for assisting in the development and coordination of risk adjustment program; including reporting efforts, data extraction, analysis, report design, report build, solution deployment and draft documentation to support the Financial and Business reporting solutions. In this role, you will participate in the design, implementation and management of a comprehensive Hierarchical Condition Category (HCC)/ Risk Adjustment Factor (RAF) strategy.<br /><br />This position offers competitive compensation, health insurance, dental insurance, life insurance, 401(k) with company match, paid time off, free parking and more. &nbsp;Qualified candidates are encouraged to apply immediately. &nbsp;AgeWell New York is a growing managed care plan, with career development and advancement opportunities.
Responsibilities: <ul> <li>Develop and maintain an expert level knowledge of Medicare and risk-based reimbursement methodologies</li> <li>Assist in the collection and analysis of qualitative and quantitative data as it relates to risk adjustment specifically around missed opportunities, prevalence and suspects</li> <li>Assist in the design and development of ad hoc reports and presentations for risk adjustment initiatives, and the development of provider assessment and scorecard</li> <li>Monitor education programs, timelines, learner progress and report to leadership when appropriate</li> <li>Assist end users to gather reporting requirements and analyze internal reporting tools</li> <li>Performs outreach on Risk Adjustment Education based on review of pre-selected charts coupled with data management, data reporting and analysis, and provider scorecards</li> <li>Provide analytical support on various strategies to ensure company goals are met</li> <li>Propose opportunities to maximize reimbursement based on CMS- HCC Model and Methodology</li> <li>Assist in developing, validating and implementing data mining strategies for members covered under risk-based models of Medicare Advantage and FIDA</li> <li>Develop enterprise-wide data collection methodology and an effective HCC/RAF coding program</li> <li>Ensure that all professional, outpatient, and inpatient claims are transmitted to CMS promptly and accurately</li> <li>Present HCC/RAF performance results and findings regularly to key internal leadership</li> <li>Participates in the Risk Adjustment data validation</li> <li>Serve as risk adjustment coding subject matter expert for Medicare plans and corporate HCC/RAF outreach teams</li> </ul>
Requirements: <p><strong>Position Qualifications:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</strong></p> <ul> <li>Strong interpersonal and customer service skills, including excellent verbal and written communication skills required</li> <li>Proven leadership skills in physician practice relationship, including efficiency, collaboration, and openness with a focus on results</li> <li>Must be organized and detail oriented with a strong bias for follow-up and problem resolution</li> <li>Proven ability to be a team player</li> <li>Master's Degree in Health Administration, Business Administration or a related field</li> <li>Current coding certification to include one of the following: CPC, CCS, CPC-H, RHIA, and/or RHIT</li> </ul> <p><strong>Experience:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</strong></p> <ul> <li>7 years of management and direct supervisory experience</li> <li>5 years of experience in a healthcare setting</li> <li>Experience working with health plans or large physician practices preferred</li> <li>Experience in analytics and data analysis, along with coding, revenue cycle, or Medicare Advantage experience</li> <li>Background in running Risk Adjustment and HCC activities and/or clinical informatics</li> <li>Experience with workforce management and medical billing software, tools and reporting</li> </ul>