Vice President, Risk Adjustment
Bright Health, Minneapolis, MN
WE’RE NEW, BUT WE’RE NOT NEW AT THIS.
- Strategy, planning, and end-to-end oversight to ensure accurate and complete risk adjustment across all Bright Health markets and products, including ACA/Exchange, Medicare Advantage, and Small Group.
- Demonstrate expert knowledge in CMS-HCC risk adjustment methodologies and industry-leading solutions and strategies to drive optimized results.
- Develop member and provider engagement strategies, including the use of value-based payments, incentives, and other levers to encourage proactive risk management.
- Partner with Analytics and Actuarial teams to develop new predictive, analytic and reporting tools to glean actionable insights into current performance and new opportunities.
- Ensure accurate and complete submission of claim and diagnosis data through CMS encounters process and EDGE servers to drive maximum revenue capture.
- Monitor risk adjustment submissions as compared to expected revenue and proactively address gaps in data submissions and impacts to forecasting and budgets.
- Institute monitoring and auditing protocols to ensure internal and vendor compliance with all applicable regulations and risk adjustment data validation audits (RADV).
- Develop and manage a multi-million dollar department budget, select and performance manage key vendor partners, and foster new relationships and partnerships with cutting edge service providers.
- This position has supervisory responsibilities.
EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
- Minimum of a Bachelor’s degree in business, finance, analytics, healthcare delivery, public policy or a related field is required. A Master’s degree in a related field of study is preferred.
- Ten (10) or more years’ experience in the managed care industry or related field required.
- Five (5) or more years’ experience in Medicare Advantage, Commercial, or related healthcare coding and risk adjustment is required.
- Five (5) or more years of progressive management and leadership experience.
- Coding certification a bonus but not required.
- Strong track record of leading risk adjustment for ACA/Exchange and Medicare Advantage plans.
- Proven ability to align cross-functional teams and drive action to meet internal and external business and program goals and objectives.
- Proven ability to act as a health plan business leader at the most senior organizational levels.
- Highly organized and process driven, yet agile and highly adaptable to change
- Knowledge of regulatory risk adjustment requirements and processes and audit requirements;
- Proficiency in interpreting results and formulating action plans even in the face ambiguity;
- Ability to research and analyze state/federal regulations related to health insurance and healthcare;
- Demonstrated skills in critical thinking, problem-solving, and the analysis, interpretation, and evaluation of complex information;
- Excellent interpersonal, cross-functional coordination and communication skills.
- Demonstrated success in running and managing many projects at one time
- Demonstrated success in supporting internal clients and departments
- Computer skills: Microsoft Word; Excel; PowerPoint; and database software.
About Bright Health
Here’s the great thing about building a health plan from the ground up. We get to ask "why" at every turn – and make every decision a thoughtful one. But we’re different than other new health insurance companies because we come from big places. Our leaders have decades of experience working in health insurance and are committed to improving the customer experience. They started Bright Health because they know what to do and, more importantly, what not to do when creating a system that will actually work in your favor. Bright Health believes healthcare can be done better. Our carefully selected network: When we sat down to design Bright Health plans, we were thinking about relationships – the one between you and your doctor, and also the one between us and your doctor. Then we set out to create purposeful partnerships with caring providers. We call them our Care Partner. Our tight-knit network gives you access to a community of compassionate providers who are working together with us and with each other to help you live Brighter. Our commitment to service: When you need care, you want someone familiar who can help you, someone who actually feels good to interact with. And in-between visits to the doctor, you want someone who will help you thrive. So with any Bright Health plan, you get us, your Bright Health Team. We’re here, ready to help. No matter if your question is “Can I see this doctor?” or “How much is covered?” it’s easy to reach a real person who can get you the right answers and help you find the right care. There, that’s better. Our Whole Health Rewards: Keeping good health extends far beyond how many steps you take, what your BMI is, or what kind of food you eat. Don’t get us wrong, those things certainly contribute to your well-being but there’s a whole lot more to the picture. We provide opportunities for you to earn $$ throughout the year for making good decisions that lead to a Brighter life. When you and your health plan both want what’s best for you – it makes staying well a whole lot easier.
Want to learn more about Bright Health? Visit Bright Health's website.
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