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Employment Type : Full-Time
Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age. Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths. Position Overview: The Director of Risk Assessment reports to the Vice President, Quality and Population Health and will oversee the accuracy and comprehensiveness of HCC reporting to CMS. This position manages a coordinated, cross-functional and integrated process across the organization to implement programs and streamline activities. The Director will also develop, implement, and lead enterprise Risk Adjustment programs to ensure that risk exposures and opportunities are identified timely and appropriately, with a goal to optimize the program. This job will ensure compliance to all applicable laws, guidance, and regulations. The Director will interface with providers, vendors, and clinical leadership to develop programs that deliver measurable, actionable solutions resulting in improved accuracy of medical record documentation and coding. Oversee risk adjustment coding team and core functions to ensure Hierarchical Condition Categories (HCC) coding guidelines are met using industry best practice. This includes medical record retrieval, provider chart audit, and provider feedback. This individual will partner with internal teams such as Finance, IT, Operations, and Quality to streamline and leverage opportunities to jointly develop and implement optimization strategies. Specific accountabilities within the job include program development, program management, vendor oversight, provider and member outreach where applicable, and oversight of the business intelligence necessary to drive optimal performance for the Medicare Advantage, Commercial Affordable Care Act, and Medicaid business. Essential Responsibilities:
Supporting Responsibilities:
SUCCESS PROFILE Work Experience: 5 years experience in a healthcare setting with 3 years experience directly related to risk adjustment required. At least 3 years experience managing teams required. Must have in depth knowledge of risk adjustment strategies including prospective tools, retrospective tools, data submission guidelines, and provider engagement strategies. Experience managing vendor relationships preferred. Familiarity with pricing models for each line of business is highly preferred. Experience influencing and managing value based contracts with provider groups also highly preferred. Experience with Medicaid, Medicare and Commercial health services operations, strategic planning and system design in health plans is preferred. Education, Certificates, Licenses: Bachelor’s Degree in health related field and/or mathematics, statistics. Advance degree preferred. Competencies
Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 10% of the time. Our Values We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:
Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively. Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.