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Vice President, Medicare Risk Adjustment

Expired Job

Iora Health Boston , MA 02298

Posted 5 months ago

About Iora Health

Iora Health is transforming health care, starting with primary care. We created a high-impact relationship based care model, that particularly benefits adults on Medicare and those who might need more attention. Our care model changes everything - the team, outcome-focused payment, customer service, and the technology that supports our care.

We know that when you invest in relationships with people, you can help them live happier and healthier. Our patients get a team that respects and listens to them. We get paid to keep our patients healthier, and it works - we are successfully improving the lives of our patients while lowering costs.

The Role

We are hiring a Vice President to lead our Medicare Risk Adjustment activities. The Risk Adjustment team manages our end-to-end clinical documentation process, from eligibility and on-boarding to claims submission and reporting. Reporting to the Chief Financial Officer, you will directly manage all revenue initiatives and work cross-functionally with our clinical and technical teams to develop the tools, processes and reporting required to ensure compliance with a complete and accurate coding and billing function. Success in this role requires a systems-thinker with extensive experience in Medicare Risk Adjustment. The individual will gain the unique opportunity to shape a Risk Adjustment and revenue cycle function that operates effectively while allowing our care teams to do what they do best - help our patients live their best lives.

Responsibilities:

  • Partner with CFO, Chief Medical Officer, and Medical Risk Physician Director to plan the strategic direction of risk adjustment initiatives to ensure complete, accurate and appropriate diagnosis capture, and sustainable business performance to achieve organizational goals.

  • Create, implement, and maintain all systems required to intake clinical information for new patients and to compliantly submit claims and encounter documentation to our health plan and CMS partners

  • Manage a team of individuals dedicated to this work, including those focused on Clinical Documentation and Medicare Risk Education

  • Manage all third party coding and billing partners

  • Use analytics to define Medicare Risk Adjustment focus and work internally with VP, Clinical Performance to align and optimize quality and risk adjustment metrics opportunities.

  • Leads the development of key analytics and data to support revenue forecasts, analysis and reporting to engage key stakeholders and communicate program results to the organization

  • Provide management reports for data sourcing, uploading and reconciliation with CMS and health plan partners

  • Work closely with our in-house Legal & Compliance Team on Risk Adjustment Data Validation Audits

  • Perform other duties as assigned

Qualifications:

  • Bachelor's degree in business, health administration, health policy, finance or a related field is required. Master's degree preferred

  • 5+ years demonstrated success optimizing Medicare Risk Adjustment, ideally in a physician-led organization

  • 5+ years leadership and/or management experience required

  • Solid knowledge of the industry and crossfunctional work experiences in the areas of health insurance finance, medical economics, actuarial, underwriting, and/or risk adjustment

  • AHIMA, ACDIS, AAPC (CPC or CRC) or Risk Adjustment Practitioner coding certification Healthcare Coding Practices preferred

  • Demonstrated success working in a matrix environment and leading cross functional teams

  • Demonstrated interpersonal, communications and team building skills

  • Ability to explain, engage and coach providers around functional expertise

  • Strategic ability to see the big picture and connect dots across an organization

  • Strong oral and written communication

  • This role requires 10-15% travel

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Vice President, Medicare Risk Adjustment

Expired Job

Iora Health