Risk Adjustment Director

Job Locations US-IL-Chicago
ID
2024-4683
Category
Analytics
Type
Active/Full Time/Regular

Job Summary

WELLBE INTRODUCTION

The WellBe care model is a Physician Led Advanced Practice clinician driven geriatric care (care of older adults) team focused on the care of the frail, poly-chronic, elderly Medicare Advantage patients.  This population is typically underserved and very challenged with access to care.   To address these problems, we have elected to bring the care to the patient, instead of trying to bring the patient to the care. Care is provided throughout the entire continuum of care – from chronic care and urgent care in the home, to hospital, to skilled nursing facility, to assisted living, to palliative care, to end of life care.  WellBe's physician/advanced practicing clinician led geriatric care teams’ partner with the patient’s primary care physician to provide concierge level geriatric medical care and social support in the home as well as delivering and coordinating across the entire care continuum.

 

GENERAL SUMMARY

Sr. Director of Risk Adjustment will lead enterprise risk adjustment analytics for the organization. They will be required to be hands on and develop metrics, algorithms, and workflows related to forecasting RAF/value, supporting prospective point of care tools, while supporting and developing the analytics team. This individual will interface with senior leaders and will need to have excellent communication and presentation skills. This position will also be required to foster growth and support for analysts on the team, even though it is an individual contributor role.

Job Description

  • They will be required to be hands on and develop metrics, algorithms, and workflows related to forecasting RAF/value, supporting prospective point of care tools, while supporting and developing the analytics team.
  • This individual will interface with senior leaders and will need to have excellent communication and presentation skills.
  • This position will also be required to foster growth and support for analysts on the team, even though it is an individual contributor role.

Job Requirements

SKILLS & COMPETENCIES

  • Expertise handling Tableau products

QUALIFICATIONS

  • 10 years or more of experience in health care, managed care, health insurance or strategic consulting
  • 10 years or more of experience with Medicare Risk Adjustment operational processes and payment methodology
  • Workflow analysis experience relevant to the relationship between claims, encounters, and risk adjustment
  • Excellent analytical, presentation and verbal and written communication skills
  • Executive presence with the ability to influence inside and outside of the WellBe organization

Educational Requirements:

  • Master’s degree in Math, Finance, Stats, or MBA with equivalent work experience

Required Skills and Abilities:

  • Minimum of 10 years working on Medicare Risk Adjustment analytics (Forecasting, valuation, etc.) to lead and implement enterprise analytics and initiatives related to prospective and concurrent strategies and workflows
  • Excellent end to end understanding of encounter submission from health plans to CMS in order to create reconciliation reports for Finance and Actuary partners
  • Mastery knowledge of Medicare Risk adjustment workflow as it relates to retrospective (chart chases), concurrent, and prospective initiatives and how they impact RAF
  • Mastery knowledge around CMS and Payor files (MMR, MOR, MAOs, etc.) in order to develop reports and analysis that support operational and clinical workflows
  • SQL/R/Python programming required in order to develop and create data sets that support risk adjustment analytics

 

Supervisory Responsibility: No supervisory responsibilities.

 

Travel requirements: Travel may be required up to 20% locally or nationally

 

Work Conditions: Ability to lift up to 20lbs.  Moving lifting or transferring of patients may involve lifting of up to 50lbs as well as assist with weights of more than 100lbs. 

  • Ability to stand for extended periods
  • Ability to drive to patient locations (ie. home, hospital, SNF, etc)
  • Fine motor skills
  • Visual acuity

The preceding functions may not be comprehensive in scope regarding work performed by an employee assigned to this position classification.  Management reserves the right to add, modify, change or rescind the work assignments of this position. Management also reserves the right to make reasonable accommodations so that a qualified employee(s) can perform the essential functions of this role. 

 

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