Aledade, Inc. is hiring a
Senior Manager, Risk Stratification

Summary

The Senior Manager of Risk Adjustment is responsible for leading programs and processes related to risk adjustment and achieving success in accurate diagnosis documentation. This role involves collaborating with various teams, managing relationships with payers, overseeing reporting, working with analytics teams, developing strategies for improving risk adjustment accuracy, and more.

Requirements

• Bachelor’s degree in Healthcare Administration 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

Responsibilities

• Lead or coach process owners and improvement teams in optimizing accurate coding, billing, documentation
• Act as the liaison for multiple teams in a matrixed environment, including collaboration with clinical, market teams and compliance/legal
• Responsible for risk payer relationships
• 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

Preferred Qualifications

• MBA, MHA or other Master’s level training in health, business or IT
• 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