Director - Risk Adjustment - Connolly Healthcare - Philadelphia

Job description

This position is responsible for leading the development and delivery of the Company’s risk adjustment products and services to assist clients in validating and ensuring compliance and accuracy of high-risk clinical profiles. In addition to developing and executing upon the business strategy, the position is responsible for product management, maintaining regulatory awareness, managing client relationship, and demonstrating evolving risk adjustment expertise to ensure the Company’s competitiveness within the portfolio.

Key Responsibilities • Service Delivery. Oversee and lead all risk adjustment activities for multiple client accounts. Direct the successful delivery of risk adjustment services to the client by managing the team(s) assigned to the engagement and providing leadership and direction and ensuring that the client’s needs and expectations are met and exceeded. Develop and implement key metrics to drive performance in quality and productivity and to ensure that the customer experience is consistent and satisfactory across all phases of the project. • Productivity. Direct the operational practices and procedures to deliver validation and retrospective services. Review project progress against established metrics and direct activities as needed to ensure achievement of business goals and customer expectations. Ensure effective coordination with data services and other support functions to achieve project goals. Demonstrate awareness and sensitivity to the needs of the client, the needs of the risk adjustment team, and the profitability of the engagement. • Cost Management. Continually work to improve efficiency, productivity and reduce operational costs while providing 100% compliance with customer contract and company policies. • Quality and Continuous Improvement. Support the continuous development of innovative solutions and work to optimize audit processes and efficiencies. Maintain and expand subject matter expertise in risk adjustment methodologies, regulations, and impacts from the Affordable Care Act. • Customer Service. Effectively manage customer problems and conflict, including direct communication with customers to achieve mutually-accepted resolution. Provide assistance and remove barriers as needed to identify opportunities for process improvements. Serve as top escalation point to resolve any customer issues that are roadblocks to customer satisfaction. Lead the implementation of all appropriate actions by other leaders and teams to understand and resolve issue and ensure follow through until closure and complete customer satisfaction. • Account Growth. Ensure the risk adjustment team is looking at all possible opportunities and is using all available proprietary software, reports and IT resources to conduct their projects. Collaborate with Strategic Account Management to achieve in growth opportunities within existing and potential clients. • Compliance. Ensure compliance all HIPAA regulations regarding the safe-guarding of Protected Health Information (PHI) and communicate to all associates involved in the audit engagement. • Contract Management. Partner with the client and sales team on renewals and work through any RFP process by identifying gaps in current contract in place and understanding customer needs in order to successfully renew the contract. Perform customer needs and service analysis, make recommendations on appropriate pricing structure and contract requirements, and contribute to RFP responses. Facilitate contract terminations or scope changes including identifying reason for change, defining possible solutions to customer issues to lead to retention, negotiating account transition procedures and prices. • Audit Staffing. Meet regularly with HCC support team to ensure appropriate staffing levels and to plan and organize workloads and staff assignments according to the needs of the audit. • People Management. Consistent with good people management practices and company values, provide managerial leadership and direct the selection, supervision, evaluation and development of staff. Set objectives and conduct performance reviews for direct reports and oversee the remaining evaluations indirect team members. • Performance Management. Work with Human Resources to recommend and implement performance management, progression, and compensation actions as warranted. Resolve employee concerns and other sensitive people issues consistent with Human Resources policies and guidelines. • Staff Training & Development. Follow established processes for training and career progression to enable revenue growth and auditor and support staff development and engagement. Promote & participate in knowledge sharing activities such as best practices, benchmarking, whitepapers and IT tools enhancement. Ensure that all levels of staff are properly trained on policies, procedures and best practices and that proper training, education and required certifications are maintained as required. • Succession Planning. Proactively plan for succession and growth and ensures no gap in productivity and customer service.

Desired Skills and Experience

Bachelor’s Degree or equivalent experience. Master’s in business or healthcare-related curriculum preferred. •Progressive experience working in a healthcare setting and Medicare Risk Adjustment environment. •Prior experience with direct client contact (account management, audit, sales, etc.). •P&L management

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