VP, Risk Adjustment Analytics - Jackson, United States - Evergreen Nephrology, LLC.
Description
WHO WE ARE
Evergreen Nephrology partners with nephrologists to transform kidney care through a value-based, person-centered, holistic, and comprehensive approach to kidney care.
We are committed to improving patient outcomes and improving quality of life by delaying disease progression, shifting care to the home, and accelerating kidney transplants.
We help nephrologists focus on the right patients at the right time across the full care spectrum.We do this by providing them with the best-in-class interdisciplinary clinical resources, analytical insight and tools, and services to patients.
We listen to the needs of our patients, our employees, and our client partners, continually working to push beyond the status quo in which the care system manages patients today.
WHO YOU ARE
You are passionate about creating a better healthcare journey and experience for people living with kidney disease. You are an empathetic, humble, and highly conscientious leader that inspires, challenges, and elevates team performance. You are a decisive, results-driven, self-starter who works with a sense of urgency and a bias toward action. You thrive on collaboration.
You can effectively gather appropriate insights from peers and can incorporate relevant critical inputs and subject matter expertise into plans, strategies, and processes.
YOUR ROLE
As the Vice President of Risk Adjustment Analytics with Evergreen Nephrology, you will lead the strategy and execution of our comprehensive and compliant risk adjustment, documentation, and quality programs.
Given the critical nature of complete and accurate coding which comply with CMS regulations, you'll be a highly visible and essential leader across the entire organization, working with executive leadership, finance, operations, compliance, and clinical teams.
PRIMARY FUNCTIONS
Lead the strategic design and execution of the quality and coding functions for Evergreen
Lead, coach, and develop the Evergreen quality team, coding team, and external-facing leads
Lead the creation and maintenance of billing and coding guidelines both internally and externally
Collaborate with internal clinical and operations stakeholders to ensure alignment of workflows and tracking of KPIs for quality metrics achievement
Establish processes to audit and monitor provider coding practices to ensure compliance with CMS regulations, and ensure there is a risk mitigation program
Garner buy-in, support, and cooperation of our JV partners and field team on CDQI initiatives by providing strategic vision, coding/documentation guidance & expectations, and high-quality education delivery
Provide leadership and support to manage relevant external CDQI vendor relationships
Internal subject matter expert on CMS quality metrics and technical mechanics of CMS risk adjustment models. Lead communication and progress towards relevant metrics across the organizations
Establish and maintain technical and procedural infrastructure to support all aspects of quality and risk adjustment (data capture, data analysis, suspecting, and data submission to CMS)
Identify areas for improvement in field work tools and support continuous improvement of workflows and applications
HOW YOU QUALIFY
Bachelor's degree in a related field and/or the equivalent combination of training, education, and experience
7+ years working in risk adjustment leadership roles in a Medicare Advantage environment with detailed knowledge of the CMS RAF model as well as experience working with healthcare data, specifically medical claims and/or encounter data
Proven leader with a high level of EQ skills; you effectively listen, engage, and support team members
Accept that things change quickly in an early-stage environment and are willing to pivot rapidly on priorities
Align with Evergreen's purpose, principles, and practices, encapsulated in our Culture Code
Have a history in change management within a scaled healthcare services organization
Deep understanding of clinical practice operations and areas to create efficiencies
Can effectively toggle driving strategic direction and execution-focused "in the weeds" activities
Demonstrate the ability to work effectively independently and as part of a team
Demonstrated strong business acumen of valued based healthcare operations in disease management and population health programs
Have current, relevant, and substantial knowledge of areas related to CMS, e.g., legal/regulatory, administrative, policy, protocols, and other clinical issues, especially within a managed care environment
How You are Supported
You will benefit from Evergreen Nephrology's exceptional total rewards package, including competitive base pay with bonuses, paid time off starting at 4 weeks for full time employees, 12 paid holidays per year, reimbursement for continuing medical education, 401k with match, health, dental, and vision insurance
Family friendly policies that support paid parental leave and flexible work arrangements.
As a team member you'll be supported by our robust commitment to training and development that starts with onboarding and continues throughout your career with Evergreen Nephrology
You will collaborate with like-minded healthcare professionals who, like you, understand the importance and value of Evergreen Nephrology's high-quality, value-based, care model
Pay range for this role is $190,000 to $230,000, with exact pay determined based on experience, education, demand for role, and other role-specific criteria.
We take affirmative action to ensure equal opportunity for all applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, Veteran status, or other legally protected characteristics.
Learn more about your EEO rights as an applicant (Opens in a new window).
Evergreen Nephrology will not discriminate or retaliate against applicants who inquire about, disclose, or discuss their compensation or that of other applicants.
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Evergreen Nephrology is committed to working with and providing reasonable accommodations to job applicants with physical or mental disabilities. Applicants with a disability who require a reasonable accommodation for any part of the application or hiring process should email hwasielewski-
for assistance. Reasonable accommodations will be determined on a case-by-case basis.
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