Job Description:

Job Description**Must live in the South Florida area - this is not a remote position**Roles and ResponsibilitiesOversee, coordinate, or perform data mining and data-driven analysis to forecastevaluate the performance of the risk adjustment program and refine annual risk adjustment program strategies to achieve optimal performance. Incorporate data-driven analysis into the risk adjustment processes.Develop and monitor metrics of program success.Oversight of vendor relationships to drive program success (analytics, practice management).Oversight of client contractual requirements and deliverables.Development and monitoring of provider scheduling and prioritization.Identification and development of training opportunities to drive success.Identification and development of process improvement.Measurement and presentation of financial impact to executive leadership.Working across matrixed organization to drive results.Establishes operating policies and procedures for all risk adjustment programs and processes in coordination with internal and external operational units.Represent the organization in dealing with vendors, delegated entities, providers and the Centers for Medicare and Medicaid Services (CMS).Determining resource needs to support incremental functionality required for government products; contributes to budget, and acquires resources accordingly.Develops and maintains relationships with key medical leadersEducation & QualificationsSouth Florida area candidates or candidates willing to relocateBachelor's degree from a four-year college requiredRHIARHIT required credentials preferredSpecialization in building business units to become more effective and efficient while fostering a team environment7+ years' experience working in a value-based provider group, health plan, andor vendor contracting with health plans providing annual wellnessrisk adjustment services5+ years' experience in a leadership role in a capacity developing and implementing risk adjustment, coding, wellness assessment, and analytics programs and processesExpertise in Medicare programs and regulations including fraud and abuse and Medicare Hierarchical Condition Coding Risk AdjustmentExcellent analysis and presentation skillsExperience working in high-growth environment preferredValid driver's license