Manager, Medicare and Medicaid Risk Adjustment

Job Summary

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are at the forefront of transformation with one of the world’s leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage. Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills.

Essential Functions

• Lead risk adjustment strategy and operations.
• Directly manage and develop a team (including hiring, performance management, and coaching).
• Develop and present analytics that communicate ongoing financial performance.
• Lead risk adjustment operational work across the entire lifecycle of the payment process.
• Develop content and strategies for provider training, education, and medical management.
• Evaluate data quality of internal and external datasets.
• Work with vendors to help negotiate new or existing contracts.

Qualifications

• Education: Bachelor's Degree required; experience can be considered in lieu of a degree.
• Experience: At least 5-7 years of experience in managing risk adjustment programs in a healthcare setting, including direct team leadership, required.
• Knowledge, Skills, And Abilities: In-depth knowledge of risk adjustment methodologies and healthcare coding guidelines for Medicare and Medicaid lines of business. Familiarity with healthcare regulations and compliance requirements related to risk adjustment. Strong analytical and problem-solving skills. Excellent communication skills to collaborate effectively with various stakeholders. Proven ability to manage, coach, and develop direct reports. Strong problem-solving skills to address coding and documentation challenges and develop corrective action.

Additional Job Details (if Applicable)

This is a remote role that can be done from most US states with a strong preference for local candidates who could attend occasional in-person meetings. This is a Monday-Friday role with standard business hours (in Eastern time).

Pay Range

$99,465.60 - $144,643.20/Annual

Grade

8