Risk Adjustment Engagement Lead

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.  

QUALIFICATIONS 

REQUIRED QUALIFICATIONS 

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. 

Required Education 

•  High School Diploma or GED in general field of study 

Required Licenses 

• N/A 

Required Certifications 

• N/A 

PREFERRED QUALIFICATIONS 

Preferred Work Experience 

• 3 years’ experience with provider engagement or performance programs 

Preferred Education 

• Bachelor of Art or Bachelor of Science or Nursing certificate  

Preferred Licenses 

• N/A 

Preferred Certifications 

• N/A 

REQUIRED COMPETENCIES 

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.  

• Technical Skills 

• 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 COMPETENCIES 

Preferred Job Skills 

• N/A 

Preferred Professional Competencies 

• N/A 

Preferred Leadership Experience and Competencies 

• N/A 

CORPORATE RESPONSIBILITIES 

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.