Director - Risk Adjustment & Performance

February 4

🤠 Texas – Remote

Although this job is listed in Texas, this company may be open to hiring remote in other states.

⏰ Full Time

🔴 Lead

🎲 Risk

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Harbor Health

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Harbor Health is a healthcare provider offering a range of medical services, including Express Care for immediate medical needs like sore throats, seasonal allergies, and annual wellness visits. They emphasize a co-creation approach to health, working collaboratively with patients to achieve optimal health outcomes. Harbor Health provides virtual and traditional appointment options and accepts most insurance plans, ensuring accessible healthcare for their clients. With multiple clinics, including specialized Express Care locations, they focus on offering warm, welcoming, and efficient care, as evidenced by positive patient reviews.

11 - 50 employees

⚕️ Healthcare Insurance

📋 Description

• The Manager, Risk Adjustment drives process improvements and system enhancements • Uses advanced knowledge of healthcare data, systems, and operational processes to serve as subject matter experts • Maintains expert level knowledge of regulatory requirements and business significance of encounters • Drives resolution of issues and oversees activities related to encounter submission performance optimization • Monitors overall team performance; project production, coding quality, and pace of projects observing industry standards • Collaborates and participates with multiple teams throughout the business to improve operations and promote business objectives • Creates and conducts risk adjustment training for new hires and existing direct reports • Evaluates a variety of medical records and provider documentation to ensure validity and accuracy of ICD-10-CM codes • Reviews project performance; identifies and escalates coding and platform trends to management • Aligns team performance following State and Federal regulatory guidance

🎯 Requirements

• Bachelor’s degree in a relevant field of study or commensurate work experience • 5+ Years’ experience in RA Coding and Auditing • 2+ Years’ experience managing teams • 4+ Years’ experience as the subject matter expert in areas of Commercial (ACA) Risk Adjustment • 2+ Years Experience with Electronic Health Records (EHRs) and Clinical Continuity of Care Documents (CCDs) • Certified Professional Coder (CPC) • 3+ Years’ experience in leading the Risk/Encounter submission process • Familiarity with Texas Department of Insurance (TDI) rules, regulations, and law preferred • Experience in the Start Up phase of a health plan is preferred • Strong Excel and PowerPoint background • Experience in developing test cases • Background in vendor implementations

🏖️ Benefits

• Opportunity to shape, develop and mentor individuals to grow their career and impact their lives. • Collaborative and dynamic work environment • An organization made up of people who are passionate about changing the healthcare landscape. • Competitive salary and benefits package • Professional development and growth opportunities • A transparent and unique culture