InnovaCare Management Services Company, LLC

As a Manager, Risk Adjustment Operations you'll provide operational services to strengthen and improve practice operations that result in stronger patient acuity capture and improved population health management. You'll use your subject matter expertise in risk adjustment & operations experience to provide strategic direction for meaningful performance improvement that aligns with the overall corporate strategy, while considering any practice nuance.  You’ll work across different acquired practices given business need & analytical assessment.   In partnership with additional departments, you will work closely with practices to ensure their needs are captured, opportunities for improvement are identified and critical deliverables are executed.  This role is a key link between our Coding, CDI, and Management Team in delivering results at the practice level.

Additionally, responsible for identifying nuanced practice MRA strategies and executing tactics to optimize results. May develop processes, workflows, and other materials to document the operational and strategic components of initiatives. Often, conducts data analysis to identify and prioritize provider outreach opportunities for coding education and MRA initiatives.

           

Your willingness to be flexible & patient with process, while working to achieve results under tight deadlines will make you a key part of the team.  This role is new to the organization & requires someone ready to come in and build it out.

Ideally, this position would be located near Jacksonville, Fl or Central Fl, but will consider remote with expected travel.

Primary Responsibilities:

• Initially will assist “at need” corporate practices to assist them in achieving results, but as the company matures, this roll will become more defined in overseeing a market or strategic prospective program

• Working with other team owners to implement & improve results for Prospective & Retrospective Programs

• Accountable for ensuring ongoing key performance indicators are met for the company's risk adjustment program(s), including reporting KPI results on a regular cadence & speaking to outlier results. Contributes to &/or maintains risk adjustment performance management and reporting dashboard

• Provide ongoing strategic recommendations, training and coaching to provider groups on program implementation and barrier resolution

• Monitors and evaluates key performance indicators and works collaboratively with leadership to report on influencing factors and evaluating trends with internal coding team to assist with performance and optimization progress

• Support root cause analysis and develop targeted interventions designed to improve acuity capture and risk adjustment outcomes

• Assist with development and execution of Standard Operational Procedures, workflows, and process documentation policies for risk adjustment programs

• May create or pull data for analytics to create ad hoc reporting.  This may include some manual work initially when new practices are acquired, or existing systems are not integrated

Qualifications:          

• 3-5 years' experience with Medicare Risk Adjustment model

• Maintains current view of risk adjustment regulatory changes and product-specific risk model changes; ensures appropriate operational responses to regulatory and risk adjustment program

• Bachelor’s Degree

• Comfortable & experienced in working with physician offices & occasionally working with physicians directly to drive risk adjustment metrics

• Ability to interpret analytics & reporting that drive metrics

• Experienced making strategic decisions to ensure projects or priorities stay on target

• Must be able to achieve success with minimal supervision & sometimes ambiguous situations with limited data

• Advanced skills in PowerPoint & Excel, including data analysis & using formulas

• Strong organizational skills

• Available to travel to provider offices 40-60% of the time

• Experience working in a dynamic healthcare setting and/or health plan with a focus on risk adjustment operations

• Ability to think strategically and to translate strategy into measurable goals

• Detail oriented, outside of the box strategic thinker experienced in decision-making with outstanding follow through and execution of priorities

• Experience having deadline driven work & meeting those deadlines

• Experience with enterprise-wide and or cross-functional large-scale initiatives involving a wide degree of complexity

• Ability to travel up to 75% time; travel maybe on short notice & dependent on business need; most travel would be within Fl, with the potential for a few additional states in the future

• Experience presenting findings and recommendations to internal and/or external stakeholders

Preferred Qualifications:

• Master’s Degree

• Coding Certification

• Both Health Plan & Provider Office experience

• Large payer experience

• Medicaid & ACA Risk Adjustment experience

• Management Experience