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Senior Manager, Risk Stratification Operations, Remote

Aledade

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Operations

Bethesda, MD, USA

Posted on Friday, May 24, 2024

The Senior Manager of Risk Adjustment is responsible for leading programs and processes and achieving success in the domain of complete and accurate diagnosis documentation and risk adjustment. This includes working across teams in a collaborative effort to reach organizational goals.

Primary Duties:

Lead or coach process owners and improvement teams in optimizing accurate coding, billing, documentation. Acting as the liaison for multiple teams in a matrixed environment. This includes collaboration with clinical, market teams and compliance/legal.
Responsible for risk payer relationships. They will eventually lead the team who is responsible for tracking all diagnosis submissions through the entire risk process and our overall workflow.
Work with payer to promote risk programs.
Own reporting for meetings with payer leaders for our working groups related to work with Risk.
Oversee development for reporting for all stages of the risk adjustment process.
Work with BI and Impact Analytics to determine impact of various interventions.
Serve as a key Business Stakeholder and RA subject matter expert for the BI and Analytics team.
Act as the liaison with the analytics team to discuss risk trends the team has observed; understand patterns and assist with analytical interpretation.
Collaborate and support the performance team with operational execution.
Develop strategies and tactics to improve risk adjustment accuracy through technology/product and program enhancements.
Work with internal and external stakeholders on projects and programs.

Minimum Qualifications:

Bachelor’s degree in Healthcare Adm or Business (or appropriate equivalent training)
5+ years payer/healthplan/value based care company including Medicare and Commercial
5 + years risk adjustment including Medicare, MSSP
Demonstrated knowledge and experience with risk adjustment methodologies such as HCC, 3M, Milliman, etc.
5+ years of program management, project leadership and execution experience in a healthcare or product related setting.
5+ years of management experience
Strong data analytics skills
Proficiency in Microsoft Office, Project/Product management, Google Suite

Preferred:

MBA, MHA or other Master’s level training in health, business or IT
5+ years of program management, project leadership and execution experience in a healthcare or product related setting.
Demonstrated leadership ability in prior workplace, including running teams and managing high import portfolio, with internally and externally facing representation responsibilities
Advanced Microsoft Office, Project/Product manage, Analytics: SQL, PowerBI, SAS

Who We Are:

Aledade, a public benefit corporation, exists to empower the most transformational part of our health care landscape - independent primary care. We were founded in 2014, and since then, we've become the largest network of independent primary care in the country - helping practices, health centers and clinics deliver better care to their patients and thrive in value-based care. Additionally, by creating value-based contracts across a wide variety of payers, we aim to flip the script on the traditional fee-for-service model. Our work strengthens continuity of care, aligns incentives, and ensures primary care physicians are paid for what they do best - keeping patients healthy. If you want to help create a health care system that is good for patients, good for practices and good for society - and if you're eager to join a collaborative, inclusive and remote-first culture - you've come to the right place.

What Does This Mean for You?

At Aledade, you will be part of a creative culture that is driven by a passion for tackling complex issues with respect, open-mindedness and a desire to learn. You will collaborate with team members who bring a wide range of experiences, interests, backgrounds, beliefs and achievements to their work - and who are all united by a shared passion for public health and a commitment to the Aledade mission.

In addition to time off to support work-life balance and enjoyment, we offer the following comprehensive benefits package designed for the overall well-being of our team members:

Flexible work schedules and the ability to work remotely are available for many roles

Health, dental and vision insurance paid up to 80% for employees, dependents, and domestic partners Robust time off plan 21 days of PTO in your first year 2 Paid Volunteer Days & 11 paid holidays

12 weeks paid Parental Leave for all new parents

6 weeks paid sabbatical after 6 years of service

Educational Assistant Program & Clinical Employee Reimbursement Program

401(K) with up to 4% match

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And much more!

At Aledade, we don’t just accept differences, we celebrate them! We strive to attract, develop, and retain highly qualified individuals representing the diverse communities where we live and work. Aledade is committed to creating a diverse environment and is proud to be an equal opportunity employer. Employment policies and decisions at Aledade are based on merit, qualifications, performance, and business needs. All qualified candidates will receive consideration for employment without regard to age, race, color, national origin, gender (including pregnancy, childbirth or medical conditions related to pregnancy or childbirth), gender identity or expression, religion, physical or mental disability, medical condition, legally protected genetic information, marital status, veteran status, or sexual orientation.

Privacy Policy: By applying for this job, you agree to Aledade's Applicant Privacy Policy available at https://www.aledade.com/privacy-policy-applicants

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