Risk Adjustment Manager

Apply on line at http://www.alohacare.org/Careers/Default.aspx

The Company

AlohaCare is a local, non-profit health plan serving the Medicaid and Medicare dual eligible population. We provide comprehensive managed care to qualifying health plan members through well-established partnerships with quality health care providers and community-governed health centers. Our mission is to serve individuals and communities in the true spirit of aloha by ensuring and advocating access to quality health care for all. This is accomplished with emphasis on prevention and primary care through community health centers that founded us and continue to guide us as well as with others that share our commitment. As Hawaii’s third-largest health plan, AlohaCare offers comprehensive prevention, primary and specialty care coverage in order to successfully build a healthy Hawaii.

The Culture

AlohaCare employees share a passion for helping Hawaii’s most underserved communities. This passion for helping and caring for others is internalized and applied to our employees through a supportive and positive work environment, healthy work/life balance, continuous communication and a generous benefits package.

AlohaCare’s leadership empowers and engages its employees through frequent diversity, recognition, community, and educational events and programs. AlohaCare has a strong commitment to support Hawaii’s families and reinforces a healthy work/home balance for its employees. Because AlohaCare values honesty, respect and trust with both our internal and external customers, we encourage open-door, two-way communication through daily interactions, employee events and quarterly all-staff meetings. AlohaCare’s comprehensive benefits package includes low-cost medical, dental, drug and vision insurance, PTO program, 401k employer contribution, referral bonus and pretax transportation and parking program.

These employee-focused efforts contribute to a friendly, team-oriented culture which is positively reflected into the communities we serve.

The Opportunity

The Risk Adjustment Manager will be responsible for leading a team of Risk Adjustment Coding Specialists that help ensure coding accuracy and submission of health conditions for all members at AlohaCare. The Risk Adjustment Manager will run the Risk Score Optimization Program that focuses on accurate capture of risk through various cross-functional activities such as provider/member education, effective use of wellness visits, prospective/retrospective chart reviews, and accurate encounter submission. The Risk Adjustment Manager will work with other executives/managers across the company to improve internal risk adjustment processes and the performance of risk adjustment vendor(s).

Primary Duties And Responsibilities

• Responsible for all aspects of the Risk Adjustment Program for both the Medicare and Medicaid lines of business.
• Lead and manage a team of Coding Specialists focused on concurrent/retrospective medical record review and provider education
• Responsible for professional coaching and mentoring of Risk Adjustment Program team members
• Responsible for visiting providers and working with their teams onsite to help ensure risk adjustment, coding, and education initiatives are on track
• Work with other business units to improve the accuracy of risk capture from prospective and retrospective activities.
• Monitors risk adjustment KPI and develops strategies to improve performance.
• Oversees risk adjustment operations and develops supporting business collateral to effectively meet performance goals (e.g., polices, procedures, workflows, dashboards, etc.)
• Exhibits confidence and an extensive knowledge of emerging industry practices when solving business problems.
• Uses creative thinking beyond the boundary of existing industry practices and staff mindset.
• Reports to the Senior Director of Business Support Services and communicates any important information about the organization or in-flight projects.
• Other related duties as may be assigned by the CIO or Senior Director of Business Support Services.
• Responsible to maintain AlohaCare’s confidential information in accordance with AlohaCare policies, and state and federal laws, rules and regulations regarding confidentiality. Employees have access to AlohaCare data based on the data classification assigned to this job title.
  
  

Requirements

• Bachelor’s Degree or equivalent combinations of education and experience.
• Minimum of 3 years’ experience in a health plan or managed care setting with a focus on excellent process and execution
• Minimum of 3 years’ leadership/management experience
• Knowledge of Medicare Advantage and/or Hawaii Medicaid rules and regulations, preferably with experience related to Risk Adjustment policies and best practices
• Project management experience.
• Strong verbal and written communication in English.
• Requires operation of general office equipment to include PC, fax/copy machine and ACD Mitel Phones.
• Advanced skills using Microsoft Programs; Word, Excel, Outlook, and PowerPoint.
• Strong organizational skills.
• Positive attitude and ability to accept direction.
• Excellent attendance, must be punctual and reliable
• Flexibility and adaptability to changing priorities.
• Available for weekend or extra hours work during project implementation or whenever necessary to accomplish tasks.
• Must be able to telecommute if necessary, using personal equipment
  
  

Preferred Requirements

• 3 years of experience improving risk adjustment functions in a health plan or healthcare facility.
• Experience with execution, planning, and management of high priority/high visibility projects
• Previous experience with the Quest/QI Medicaid and/or and Medicare program.
• Strong financial management, organizational, negotiation, analytic, problem solving and management skills, with the ability to interpret complex data
  
  

Mental, Physical And Environmental Demands

• Sedentary Work: Exerting up to 20 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time.
• Inside working conditions
• No environmental hazards
• Requires operation of general office equipment to include PC
  
  

Salary Range: $81,000 - $100,000 annually

AlohaCare is committed to providing equal employment opportunity to all applicants in accordance with sound practices and federal and state laws. Our policy prohibits discrimination and harassment because of race, color, religion, sex (including gender identity or expression), pregnancy, age, national origin, ancestry, marital status, arrest and court record, disability, genetic information, sexual orientation, domestic or sexual violence victim status, credit history, citizenship status, military/veterans status, or other characteristics protected under applicable state and federal laws, regulations, and/or executive orders.