Risk Adjustment Engagement Lead
Awarded the Best Place to Work 2021, Blue Cross Blue Shield of Arizona helps to fulfill its mission of improving the quality of life of Arizonans by delivering a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.
Internal Use Only: GEN 29-30
PURPOSE OF THE JOB
This role will collaborate with Risk Adjustment, Provider Network and MA Leadership Team to lead RAF value based contracting activities to improve RAF ratings. In this role, data will be analyzed and developed for optimal provider performance impacting recapture of chronic CMS Hierarchical Category Conditions (HCC’s). Position will serve as an internal consultant for activities supporting the Risk Adjustment including Risk Adjustment Factor (RAF) scores and HCC recapture rates. Position will also provide strategic vision towards best practices for RAF incentive models, performance scorecards and continued performance improvement tactics. The RA Engagement Lead will employ strong analytic, consultative and communication skills to develop and execute strategies related projects and programs (internal and vendor-driven) that optimize performance across our provider networks serving Medicare markets.
Required Work Experience
3 years in a progressively responsible leadership consulting or project management role in a complex operational vertical supporting health care and vendor-based programs.
3 years’ experience supporting RAF programs (RAF scores, CMS modeling) for Medicare Advantage, Medicaid or State-Run Healthcare Programs.
High School Diploma or GED in general field of study
Preferred Work Experience
3 years’ experience with provider engagement or performance programs
Bachelor of Art or Bachelor of Science or Nursing certificate
ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES
Partner with the Revenue Operations, Provider Network and Medicare Advantage teams to utilize performance analysis methods to identify and recommend provider contracting opportunities for performance improvement
Actively participate in the development of the strategic plan for RAF and Provider Network
Monitor and evaluate progress against timelines, project milestones and key deliverables for CMS RAF improvement activities
Develop models to incentive and measure HCC recapture rates, health and wellness improvement activities.
Work in partnership with Stars team around initiatives impacting RAF and Stars.
Work in partnership with Health and Wellness/Member Outreach team to develop best practices around strategic initiatives
Develop and maintain vendor scorecards to ensure direct communication with vendors on improvement opportunities
Participate in the contract negotiation phase
Work with Revenue Operations Leadership on vendor-strategy and subsequent vendor contracts
Identify opportunities for improvement within vendor contracting structure. Leads discussions on vendor strategy best practices within Quality space
Strategize with VBCs on their internal initiatives to ensure all outreach and gap closure activities include HCC recapture / gap closure compliance (coding).? VBC initiatives must be coordinated to ensure no member abrasion and compliance needs are met.
Coordinate co-branding efforts across VBC lead initiatives
Manage VBC monthly and quarterly updates including materials development, rate insights, strategic discussions
Reporting and Presentation
Collaborate across business divisions with various departments such as Operations, Actuarial and Finance to coordinate the development of centralized dashboards/models to identify and track RAF/HCC Recapture progress.
Use technical skill set to centralize reporting package and project plans for Risk Adjustment annual projects
The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
Perform all other duties as assigned.
Required Job Skills
Advanced knowledge of Medicare, CMS Risk Adjustment Modeling. CMS RAF standards
Previous experience working in strategy development and implementation, analytical and CMS Risk Adjustment process improvement in the health care health insurance sector or management analytics.
Microsoft Access, Microsoft Excel, Microsoft PowerPoint (Advanced)
Excellent writing skills with the ability to compose and deliver a variety of business correspondence
Excellent verbal skills including ability to present to a variant of audiences
Required Professional Competencies
Ability to hold providers accountable for program performance
Demonstrated analytical and critical thinking skills
Demonstrated interpersonal/verbal communication skills
Demonstrated written communication skills
Ability to work in a matrixed environment
Ability to work as part of a team
Ability to manage a project-based portfolio with constant deliverables
Adept at partnership and collaboration both internally and externally
Required Leadership Experience and Competencies
Strong leadership skills with proven ability to lead change to accommodate evolving organizational and regulatory processes.
Preferred Job Skills
Preferred Professional Competencies
Preferred Leadership Experience and Competencies
This position generally works within guidelines and policies but participates and provides input on policy changes within a department or similar departments across the region or company. Incumbent performs essential functions with limited supervision.
BCBSAZ does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.
Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.