The Director of Risk Adjustment (RA) coordinates and oversees the analysis, monitoring, reporting, and forecasting of RA activities for the Government Programs lines of business, such as Medicare Advantage, Commercial Individual and Small Group and Medicaid member populations. This position keeps abreast of new RA legislation and regulations and is responsible for analyzing and communicating the potential impact to the rest of Community Health Choice. This position leads the alignment of all Risk Adjustment initiatives occurring within other functional teams such as Quality, Compliance, Operations, Legal, and Actuarial to improve the completeness and accuracy of RA data submitted to CMS and HHS. The Director identifies opportunities to improve all encounter data submitted to CMS, as submissions are leveraged to calculate risk scores, which directly impact revenue. The Director collaborates with the operations team responsible for managing encounter data submissions to CMS and the HHS EDGE server, leading studies, modeling risk scores and providing supporting analysis to improve RA performance. This role also serves as a liaison with vendors and is responsible for monitoring, executing, and enhancing the success of RA initiatives.
Bachelor's degree (Business, Economics, Public Health, or another related field) required.
Master's degree or extensive experience in healthcare industry preferred.
Ten years in healthcare industry, specifically data management required.
Seven years as an executive of healthcare data /analytics required.
Ten years of progressive management / leadership in financial and performance management required.
The Harris Health System is a fully integrated healthcare system that cares for all residents of Harris County, Texas. We are the first accredited healthcare institution in Harris County to be designated by the National Committee for Quality Assurance as a Patient-Centered Medical Home, and are one of the largest systems in the country to achieve the quality standard. Our system includes 23 community health centers, five school-based clinics, a dental center and dialysis center, mobile health units, a rehabilitation and specialty hospital and two full-service hospitals.Ben Taub Hospital is a world renowned Level I Trauma Center with 586 licensed acute-care beds and provides a wide range of specialty care outpatient services. Lyndon B. Johnson Hospital is a 328 licensed bed acute-care hospital with a newly expanded Level III trauma center and a distinguished regional center for neonatal intensive care for high-risk deliveries.Harris Health is a teaching system for Baylor College of Medicine and The University of Texas Health Science Center at Houston (UTHealth). We train the next generation of healthcare providers on the latest medical procedures and technological breakthroughs.With... our fully integrated electronic medical records system, we offer patients the convenience and assurance that their medical history is accurate, safe and available when and where it is needed. Our Medical Home designation ensures that we offer a full range of preventive, specialty and acute care services for the entire family.