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VP of Risk Adjustment

Company: InnovaCare Health - MMM of Florida
Location: White Plains
Posted on: September 13, 2020

Job Description:

Corporate Headquarters

173 Bridge Plaza North

Fort Lee, NJ 07024

Innovacare Health operates a growing family of integrated healthcare companies focused on improving the health of patient populations through value-based, coordinated care. Through physician-led models and cutting-edge technology, InnovaCare has built a 20-year track record of growth and a national reputation for excellence. In each unique market the company enters, InnovaCare works across the healthcare ecosystem – with patients, providers, payers and other partners – to increase access to high-quality, coordinated care.

Based in White Plains, N.Y., InnovaCare manages nearly 600,000 lives, including one of the highest percentages of dual-eligible beneficiaries in the nation. Since 1998, InnovaCare and its subsidiaries have been market leaders in transforming healthcare by distributing risk and developing proprietary technologies to inspire patient and provider engagement. The company’s physician practices and health plans have continuously received some of the nation’s highest scores for quality from the Centers for Medicare and Medicaid Services (CMS).

With strong financial support from a leading global investment firm, Summit Partners, InnovaCare combines management expertise, value-based solutions, best-in-class technology and data analytics to achieve industry-leading outcomes and deliver the best possible experience to members and patients.

Summit Partners is a global alternative investment firm that currently manages more than $19 billion in capital dedicated to growth equity, fixed income and public equity opportunities. Summit invests across growth sectors of the economy and has invested in more than 500 companies in technology, healthcare, consumer, financial and business services, and other growth industries. Summit maintains offices in North America and Europe, and invests in companies around the world.

POSITION SUMMARY

InnovaCare is seeking a very qualified VP of Risk Adjustment with extensive leadership experience in the area of managed care / health plan setting. This remote position entails about 50% travel to Florida and Puerto Rico offices.

Position Summary :

VP of Risk Adjustment

Job Description : The Vice President of Risk Adjustment is responsible for the oversight of risk adjustment and coding within the organization and plays a critical role in the development and execution of business strategy and compliance of a growing healthcare enterprise that is currently the 9th largest Medicare Advantage plan in the country.

Oversees the development, implementation and execution of compliant of Medicare advantage and Managed Medicaid risk adjustment strategy utilizing CMS HCC and CDPS models, respectively. This leadership role interacts as a key business partner to the Chief Medical Officer, Market Leaders, product design, and strategic planning.

Role Specific Competencies:

Influential Leadership

Managing Vision and Purpose

Strategic Agility

Customer Focus

Driving for Results

Innovation

Education Requirements:

A Master’s degree in Business Administration, Public Health or Healthcare Administration preferred.

Qualifications :

Strong business fundamentals and prior experience in Health Services are a requirement. Individual will have proven leadership capabilities, executive presence, outstanding communication skills and be proficient at driving change.

Professional Experience and Knowledge

7 years leadership experience at a senior level, preferably with a large organization and multi-site locations.

Experience in a complex healthcare delivery environment, including risk assessment and revenue optimization.

Significant experience setting strategy for Risk Assessment, Medical Coding, and designing models for effective improvement of proper documentation and coding of clinical diagnoses.

Possess a proven track record of leading high performing teams and developing new product/service offerings.

Excellent leadership skills including ability to think strategically, develop vision, and execute for results.

Proven ability to innovate and drive large organization change.

Experience working in a large highly matrixed organization, with proven ability to develop internal enterprise relations, and external relationships.

Excellent presentation and communication skills.

Strong business and financial background with a sense of urgency and a desire to achieve top line results in a fully appropriate and compliant manner.

Demonstrated experience in risk assessment and revenue optimization achieved through informatics and analytic data.

Skills • Strong knowledge of Medicare and Medicaid Risk Adjustment, including technical requirements as well as challenges health plans and providers may have in meeting reporting requirements • Understanding of applicable CMS Medicare Part C & D reporting requirements including manuals, review guides and Code of Federal Regulations • Ability to interact with internal and external customers at all management levels • Project management and/or consulting experience a plus • Strong problem solving ability and a customer centric focus • Be team focused with an attitude of group achievement as the primary goal • Highly organized with a strong attention to detail • Demonstrated leadership and management skills • Effective collaboration skills and experience • MS Office proficiency • Strong oral and written communication skills, including presentation skills • Ability to work in a virtual office and virtual teaming experience

Duties & Responsibilities • Responsible for project planning, management and execution of key initiatives and projects • Responsible for the development of new scopes of work and refinement of existing scopes of work to assure they meet company’s current needs • Provides guidance and information, when requested, as an internal resource • Provide industry guidance to staff within the Risk Adjustment and Coding Department • Ensure skill sets of staff are up-to-date and at the highest level of industry standards

Responsibilities:

Serves as the strategic leader accountable for utilizing analytics coupled with clinical technology to maximize growth and drive continuous improvement in appropriate documentation and coding.

Oversees physician education and engagement strategy and execution for risk adjustment; and national and market-based coding, and related vendor relationships.

Drives technological advancement; Oversees the development and execution of risk adjustment programs that ensure timely and accurate assessment and reporting of chronic conditions.

Ensures that staff collaborates with medical leadership, market leaders, and utilization management leaders to stay current with market trends/needs;

Keywords: InnovaCare Health - MMM of Florida, White Plains , VP of Risk Adjustment, Other , White Plains, New York

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