Director of Risk Adjustment

Job description

Summary: Location: Monarch Place; Springfield MA (MA & CT candidates only) Schedule: Monday-Friday; fulltime; 40hrs. Job Responsibilities: - Develops and implements risk adjustment strategy, policies and standard operating procedures - Collaborates with physicians, mid-level providers, other personnel, including coding experts, in risk adjustment review of the medical record - Serves as Health New England’s ambassador in the Risk Adjustment Community - Works with industry on best practices for risk adjustment - Manages, measures, and evaluates performance of Health New England’s risk adjustment vendors - Manages all data submission requirements - Prepares risk adjustment training programs for network physicians, mid-level providers, and plan personnel - Ensures that all risk adjustment related activities are compliant with CMS/ACA and state requirements - Serves as the risk adjustment compliance point of contact for HNE’s Compliance Department - Collaborates with data management personnel in the appropriate formatting and methodology of risk adjustment analysis and related reporting - Develops productivity standards for risk adjustment auditing of claims or medical records - Collab...