[Hiring] Risk Adjustment Director @Central California Alliance for Health

Role Description

We have an opportunity to join the Alliance as the Risk Adjustment Director leading the Risk Adjustment Department. This position can be located in one of our service counties (Mariposa, Merced, Monterey, Santa Cruz, or San Benito) or remotely in California with expected travel to Alliance service area(s) once a quarter. Must reside in California upon hire.

Reporting to the Chief Financial Officer, you will:

• Provide strategic management oversight in designing, implementing, directing, and monitoring the Alliance’s Risk Adjustment Department functions.
• Direct the Risk Adjustment Department, act as a subject matter expert, and provide executive-level advice and guidance on coding and risk adjustment methodologies and overall business operations.
• Direct, manage, and supervise Risk Adjustment Department staff.

Qualifications

• A motivated and seasoned leader in the managed care industry, with expertise in risk adjustments.
• Excellent communication skills, with strength in building relationships and partnering with cross-functional teams.
• Champion accountability across the organization.
• Experience in overseeing the Medicare Risk Adjustment life cycle.
• Strong data and analytical skills, including SQL, dashboarding, and reporting.
• Be invested in staff development and empowering teams to do their best work.
• Medi-Cal experience is a plus.

Requirements

To read the full position description and list of requirements, click here .

• Knowledge of the managed care industry and of Medicare health insurance payment methodologies.
• Medicare (Hierarchical Condition Categories) risk adjustment models.
• Methods and techniques of developing and delivering data management strategies that support contract analysis, trend management, budgeting, forecasting, strategic planning, and healthcare operations.
• Principles and practices of provider reimbursement methodologies, pricing, and fee schedules for all provider types, including hospital, physician, and ancillary providers.
• Healthcare industry specific terms and healthcare related data types and structures, including member, claims, clinical, and provider types.
• Methods and techniques of valuating for physician and inpatient and outpatient hospital costs.

• Ability to demonstrate strong analytical skills, accurately collect, manage, and analyze data, identify issues, offer recommendations and potential consequences, and mitigate risk.
• Perform complex analysis related to rate negotiations, health care cost reports, and determination of rates for hospitals, clinics, long-term care facilities, allied health services, professional services, and specialist services.
• Develop, plan, organize, and direct finance programs and activities that are complex in nature and regional in scope.
• Provide leadership, facilitate meetings, and partner with and guide managers and employees in the resolution of issues.
• Demonstrate a collaborative management style, build rapport, demonstrate excellent public relations skills, and effectively manage internal and external business relationships.

Education and Experience

• Bachelor’s degree in Finance, Business, Healthcare Administration, Mathematics, Statistics, or a closely related field.
• A minimum of ten years of experience in healthcare finance or analytics, which included a minimum of five years of experience with Medicare risk adjustment processes, a minimum of two years of experience related to Medicare Managed Care Programs, and a minimum of three years of supervisory experience (a Master’s degree may substitute for two years of general healthcare finance or analytics experience); or an equivalent combination of education and experience may be qualifying.

Benefits

• Medical, Dental and Vision Plans.
• Ample Paid Time Off.
• 12 Paid Holidays per year.
• 401(a) Retirement Plan.
• 457 Deferred Compensation Plan.
• Robust Health and Wellness Program.
• Onsite EV Charging Stations.

Company Description

We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.

Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve members in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties.