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    Vice President of Risk Coding - Los Angeles, United States - Healthly

    Healthly
    Healthly Los Angeles, United States

    4 weeks ago

    Default job background
    Description


    As the Vice President of Coding, you will spearhead the strategic direction and implementation of our Risk Adjustment Programs, ensuring they maximize clinical efficacy, financial precision, and compliance with regulatory standards, notably those set by the Center for Medicare and Medicaid Services.

    Collaborating closely with leadership, you will provide strategic insights and tactical recommendations to enhance program efficacy.

    Key Responsibilities

    • Lead operational initiatives in risk adjustment, focusing on monitoring, oversight, and compliance to ensure accurate risk score calculation.
    • Ensure full program compliance with state, federal, and partner regulations, mitigating risks associated with noncompliance.
    • Drive the adoption of industry best practices to optimize key performance indicators such as visit numbers, RAF score, and coding accuracy.
    • Establish and implement streamlined processes across the organization to enhance program effectiveness.
    • Define program objectives and key performance indicators to foster accountability throughout the organization.
    • Collaborate with Finance and Analytics teams to develop risk adjustment analytics, including predictive modeling for coding enhancements and provider accuracy.
    • Work closely with crossfunctional teams and external vendors to execute the MRA strategy effectively.
    • Coordinate with Provider Network Management and Quality Program to optimize risk adjustment tactics, focusing on provider and member engagement.
    • Manage processes related to athome wellness visits, ensuring documentation accuracy and compliance.
    • Collaborate with payer partners and oversee vendor relationships to ensure performance standards are met.
    • Implement robust auditing practices to drive compliance and performance excellence.
    Please note that this job description may evolve to accommodate changing organizational needs.

    Qualifications


    Required Education and Experience:

    • Minimum of 7 years experience leading and executing comprehensive Medicare Advantage MRA programs at scale.
    • Demonstrated expertise in commercial and/or Medicare Advantage risk adjustment functions.
    • Proven track record of collaborative work with clinical and operational teams.
    Knowledge, Skills, And Abilities

    • Effective communication skills, particularly in highpressure situations with clinicians and care teams.
    • Strong leadership skills with the ability to influence and engage crossfunctional teams.
    • Experience in building and nurturing networks with internal and external stakeholders.
    • Exceptional business acumen, strategic thinking, and problemsolving abilities.
    • Adaptability to thrive in a fastpaced, matrixed environment.
    • Demonstrated ability to independently lead complex, crossfunctional projects.
    • Highly organized and systematic approach to work.
    Ideal candidate is in Southern California

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