What are the responsibilities and job description for the Senior Risk Adjustment Specialist position at MetroPlus Health Plan?
Senior Risk Adjustment Specialist
Job Ref : 116871
Category : Finance
Department : ANALYTICS AND REPORTING
Location : 50 Water Street, 7th Floor, New York, NY 10004
Job Type : Regular
Employment Type : Full-Time
Hire In Rate : $96,600.00
Salary Range : $96,600.00 - $96,600.00
Empower. Unite. Care.
MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.
About NYC Health Hospitals
MetroPlus Health provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health Hospitals, the largest public health system in the United States, MetroPlus Health's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus Health has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.
Position Overview
The Senior Risk Adjustment Specialist is a critical team member in the execution of the MetroPlusHealth Risk Adjustment strategy. Your responsibilities will include management of vendors and reporting on their performance, including identifying and resolving issues. You will collaborate with internal and external partners to identify new opportunities and resolve issues as they arise. You will also use SQL and database skills to prepare reports, monitor progress, and provide ongoing and ad-hoc reports to critical partners. In addition, you will assist the Coding Quality team where needed on internal or external diagnosis coding audits. The ideal candidate will have a background in Healthcare Analytics, Health Plan Financial Reporting and / or Risk Adjustment.
Job Description
- Use SQL or another programming language to query our Enterprise Data Warehouse to prepare reports and create Key Performance Indicators (KPIs).
- Use data to measure performance of external stakeholders, communicate results and create plans to improve outcomes.
- Proactively work with external and internal partners to resolve issues - this includes identifying the root cause, devising plans to remediate, and ensuring on-time completion from all stakeholders.
- Independently manage various projects related to risk score accuracy, including supplemental chart reviews, provider outreach and member engagement.
- Work with Coding Quality team to ensure diagnosis code capture is accurate and that audits are responded to in a timely manner.
- Apply your understanding of Risk Adjustment Models and State and Federal regulatory guidelines to ensure all projects are conducted in a compliant manner.
Minimum Qualifications
Professional Competencies
LI-Hybrid
MPH50
Salary : $96,600
