Risk Adjustment Program Director, Spvsr

Job Number
201030
Banner Health Network & Banner Plan Administration
Shift
Day
Department
Banner Health Network & Banner Plan Administration - Risk Adjustment
Position Type
FT: Full-Time
Street Address
1441 N. 12th St.
City & State
US-AZ-Phoenix
Posting Category
Leadership - Non-Clinical
New Grad
No

---

The Risk Adjustment Program Director is focused on the daily management of the risk adjustment team, including the 9 field-based coders, prospective initiative and retrospective implementation of initiatives to support a comprehensive risk adjustment program. Serves as the voice of coding for the BHN network.

 

Requires a bachelors degree in business, healthcare administration or related field. Five or more years of healthcare experience to understand, lead and oversee medical risk adjustment programs across multiple accountable care organizations (ACO). Extensive experience working with medical documentation and the principles governing healthcare reimbursement, including ICD-10/CPT coding. Excellent verbal, written and interpersonal communication skills to effectively interact with all levels in the organization. Ability to function effectively in a team oriented, fast-paced environment utilizing strong critical thinking skills. Proficiency in personal software applications, including word processing, generating spreadsheets, and creating graphics/presentations.

---

About Banner Health Network & Banner Plan Administration
Banner Health Network (BHN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County. Through BHN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs.

 

Truven-2013
Stage7-2013

About Banner Health
Banner Health is one of the largest, nonprofit health care systems in the country and the leading nonprofit provider of hospital services in all the communities we serve. Throughout our network of hospitals, primary care health centers, research centers, labs, physician practices and more, our skilled and compassionate professionals use the latest technology to change the way care is provided. The many locations, career opportunities and benefits offered at Banner Health help to make the Banner Journey unique and fulfilling for every employee.

---

Job Summary

This position provides operational leadership and oversight to the organizations Hierarchical Condition Category (HCC) revenue function by developing and implementing policies, programs and standards to ensure the Risk Adjustment Factor (RAF) accurately reflects the membership health profile. This includes collaborating with key stakeholders to oversee the activities across the organizations Accountable Care Organizations (ACOs).

 

Essential Functions

  • Oversees and/or directs the development and implementation of policies, programs and standards for the organizations ACO HCC revenue function. Ensures RAF accurately reflects the membership health profiles, as well as completeness of the Medicare risk adjustment data, to ensure compliance with all Centers for Medicare and Medicaid Services (CMS) regulations and guidelines.

 

  • Establishes and oversees the development and implementation of programs, short and long-range goals and objectives and determines the optimal progression to obtain these goals. Reviews analyses and reports of various activities to determine department progress toward stated goals and objectives.

 

  • Develops and maintains documentation to support consistent and accurate administration of the Medicare Risk Adjustment processes. Maintains a current professional and technical knowledge relating CMS requirements and directives for Risk Adjustment to ensure policies and procedures meet compliance requirements.

 

  • Oversees and monitors data submission for attestation to CMS for Risk Adjustment. This position also analyzes and monitors clinical Risk Adjustment reports to and from CMS to ensure data accuracy and compliance. Reviews, prepares, analyzes, and presents reports and recommendations to senior management, as needed.

 

  • Oversees branding, marketing and communication strategies for the ACO in support of the organization.

 

  • Develops and oversees the operations budget in conjunction with corporate goals and objectives. This position is accountable for meeting annual budgetary goals.

 

 

Minimum Qualifications

Must possess a strong knowledge of business and/or healthcare as normally obtained through the completion of a bachelors degree in business, healthcare administration or related field.

Must possess progressively responsible experience working with medical documentation and the principles governing healthcare reimbursement, including ICD-10 coding. Must possess five or more years of healthcare experience to understand, lead and oversee medical risk adjustment programs across multiple accountable care organizations (ACO). Requires proven record of successfully leading and directing a large-scale projects and programs, along with personal presentation and negotiation skills to build consensus and implement advanced business solutions.. Requires thorough familiarity with workflow and process improvement applicable to a healthcare setting.

Must possess strong oral, written and interpersonal communication skills to effectively interact with all levels in the organization. Ability to function effectively in a team oriented, fast-paced environment that requires application of critical thinking skills. Position requires proficiency in personal software applications, including word processing, generating spreadsheets, and creating graphics/presentations.

Preferred Qualifications

Masters degree preferred.

Additional related education and/or experience preferred.