What are the responsibilities and job description for the VP, Risk Adjustment position at MAXhealth?
ABOUT MAXHEALTH
MaxHealth is dedicated to simplifying healthcare and ensuring healthier futures. Founded in 2015, MaxHealth is a leading primary care platform focused on providing high-quality, integrated care to adults and senior patients throughout Florida. We provide care for more than 110,000 lives, most of which are beneficiaries of government-sponsored healthcare programs like Medicare, or of health plans purchased on the Affordable Care Act exchange marketplace.
We are customer-centered; compassionate; results-driven; proactive; collaborative; and adaptable in executing our vision to help patients live their best lives. Our mission is to deliver quality care, a simplified experience, and happiness. One patient at a time.
Location- Must be in FL, but able to travel to Tampa on a regular basis and our clinics.
The Vice President of Risk Adjustment (VP RA) is a key member of MaxHealth's Executive Leadership Team (ELT). Florida is a competitive and rapidly evolving Health Care market. The VP RA will lead and drive population health efforts and programs, clinical and continuum integration, physician performance improvement and education, and the organization's strategic direction toward clinical integration and superior value-based performance.
The VP RA is responsible for MaxHealth's Risk Adjustment Program, including establishing and managing company coding guidelines, policy and procedures. The VP RA plays a critical role in developing and executing our risk adjustment strategy. .
Reporting directly to the CEO, as a member of the MaxHealth ELT, the VP RA will participate in other critical matters such as business development, strategic planning, technology innovation and deployment, and clinical integration to deliver on improved quality of care outcomes. Lastly, the VP RA is responsible for ensuring that the risk adjustment activities meet requirements of payor contracts, government healthcare program requirements, and provider performance standards.
JOB RESPONSIBILITIES
- Oversees all risk adjustment operations and leads a team of CPC, CRC and/or clinicians.
- Oversees the design, implementation and performance of all risk adjustment processes, developments of dashboards, and educational initiatives for physicians related to risk adjustment.
- Collaborates effectively with the other cross functional teams includuing, claims, clinic operations, informatics, technology, to assist with creating enterprise-wide compliant processes for proper ICD-10-CM and risk adjustment coding..
- Accountable for designing and implementing a system strategy that leads to the overall achievement of accuracy, compliance and completeness in risk adjustment initiatives to better support overall population heath management, and reduce gaps in care.
- Develops and maintains a risk adjustment performance management dashboard in partnership with Medical Economics, Finance and Analytics teams.
- Maintains relationships with external vendors and provides ongoing support to manage initiatives across Risk Adjustment.
- Develops and maintains an expert level of knowledge of Medicare and risk-based reimbursement methodologies.
- Keeps up to date on industry trends and timely informs the organization on policy changes related to risk adjustment.
- overall risk adjustment strategy and ensures vendor accountability for performance.
- Periodically assesses monitoring and auditing protocols to ensure that they are effective and comply with applicable regulations and agency guidance.
- Prepares and provides reports on overall performance and compliance to the Board of Directors, Compliance Committee and Quality Committee.
QUALIFICATIONS
- An advanced degree in healthcare administration, business administration or a related field is desirable
- Five years of experience in a risk adjustment leadership role
- Registered Nurse, APRN or Medical Degree
- CPC or CRC
- Must be able to travel
- Demonstrated success working within a risk/shared savings model for defined populations. A deep understanding of Medicare Advantage.
- Progressive experience as a senior-level leader that includes experience in clinical integration, performance improvement, and population health management.
- A leadership role with demonstrable success in an integrated delivery system that has successfully managed risk, an IPA, an ACO, a CIN, or in a managed care setting.
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