Vice President, Risk Adjustment

Primary Duties:

• Leads a team of subject matter experts, data analysts, clinical documentation integrity specialists and coders, quality auditors and other relevant personnel, providing guidance and expertise on risk assessment methodologies. 
• Lead compliance initiatives and serve as the primary liaison for all Compliance and Legal projects, ensuring alignment with regulatory standards and organizational goals. Leverage extensive experience in developing and executing compliance-driven programs to mitigate risk and drive organizational success.
• Partner closely with tech-product-analytic teams to design and maintain sophisticated risk algorithms using patient demographics, clinical data, and other relevant factors to accurately identify high-risk patients across different patient populations. 
• Collaborate with the Analytics team to consume all available data sources from health plans, analyze large datasets and extract meaningful insights and identify trends related to patient risk profiles. 
• Develop a roadmap that defines the path to operationalize specific actions which are repeatable, measurable, and cost-effective.
• Track key performance indicators (KPIs) across all contracts related to risk stratification, including # visits, RAF score, complete and accurate diagnosis coding to the highest degree of specificity, thorough and accurate documentation, and where appropriate, diagnoses recapture rates, diagnoses re-submissions, etc. 
• Partner with clinical teams, care management, and leadership to effectively communicate risk assessments and implement targeted interventions based on risk stratification results. 
• Ensure adherence to relevant healthcare regulations and guidelines related to risk stratification and data privacy. Oversee auditors and auditing practices such as implementing an internal QA process for diagnosis coding and documentation as well as liaising between health plan risk adjustment auditors and Aledade practices.

Minimum Qualifications:

• Required: Bachelor’s Degree with 15+ years experience in healthcare. Ideal candidates will have a combination of senior-level experience and expertise in health care strategy, health plans, business development, management consulting, health care finance, and provider operations.
• Preferred: Master’s degree or other advanced degree(s) in business, health administration and/or public policy, or other relevant fields.
• 5+ years of successfully leading and executing a comprehensive Risk Stratification program at scale
• Required: Deep knowledge of Risk Stratification in Medicare Advantage and Commercial (ACA, HMO, PPO) plans are required. Preferred: Knowledge of MSSP and Medicaid. 
• Proven track record of working collaboratively with clinical and operational colleagues across the organization as well as deep experience leading teams, managing projects, and driving strategic initiatives
• Deep understanding of healthcare terminology, clinical conditions, and disease progression
• Ability to manage multiple deadlines
• Ability to communicate complex data insights effectively and sensitively to diverse stakeholders, including clinicians, executives, regulatory bodies, and care teams in stressful situations
• Ability to lead by influence to engage colleagues and lead teams cross-functionally
• Proficiency in data analysis techniques, statistical modeling, and predictive analytics
• Familiarity with data warehousing, data mining tools, and healthcare information systems
• Experience in fostering networks internally and externally

Preferred Qualifications:

• Exceptional communication and organization skills
• Project management experience 
• Systems-thinker (data management, software administration)
• Experience developing educational tools/documentation
• Passionate about healthcare and interested in making a positive impact in the field
• A committed self-starter who is able to take initiative and ownership of projects
• A collaborative team player
• Detail oriented and self-motivated to produce work that meets high standards
• Google Suite, particularly Google Sheets and Google Slides
• Tableau
• General Skills at data visualization

Physical Requirements:

• Sitting for prolonged periods of time. Extensive use of computers and keyboard. Occasional walking and lifting may be required.