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Devoted Health

Our mission: to dramatically improve the health & well-being of older Americans by caring for everyone like family

Director, Risk Adjustment Operations

RiskRiskFull TimeRemoteLeadTeam 1,001-5,000Since 2017H1B No SponsorCompany SiteLinkedIn

Location

Massachusetts

Posted

3 days ago

Salary

$144K - $216K / year

Seniority

Lead

Bachelor DegreeEnglish

Job Description

Director, Risk Adjustment Operations

Devoted Health

• This role owns the end-to-end operational success of two core pillars within Devoted’s Risk Adjustment Department: Data Submissions and the Retrospective Chart Review Program. • Lead the teams responsible for the successful submission of Devoted’s disease burden reporting by optimizing our internally developed Centers for Medicare & Medicaid Services (CMS) data submission engine. • Manage a high volume, multi-vendor retrospective medical document review operation. • Develop, implement, and achieve KPIs that measure and monitor the successful submission of our risk adjustment data. • Manage relationship with Devoted’s data submission pass-through vendor, and CSCC Operations, CMS’ data submission team. • Read and make determinations on how new and emerging CMS technical guidance impacts our data submission operations. • Maintain our data submission policies, including our policy on how we internally validate, clean, and apply inclusion and exclusion criteria to the data we submit to CMS. • Support other areas of the Risk Adjustment department to ensure end-to-end perspectives are considered for all policy and procedure decisions. • Lead the strategic execution of the multi-channel Retrospective Chart Review Program, including defining, monitoring, and enforcing rigorous Service Level Agreements (SLAs) and Key Performance Indicators (KPIs) for internal teams, offshore partners, and external vendors. • Oversee medical record retrieval in partnership with the Clinical Data Acquisition team. • Own and improve program forecasts and capacity modeling. • Evaluate and integrate AI technologies to optimize the end-to-end chart review workflow, from medical record retrieval through evaluation. • Support QA and audit processes to achieve or exceed 95% coding accuracy. • Support other areas of the Risk Adjustment department to ensure end-to-end perspectives are considered for all policy and procedure decisions.

Job Requirements

  • Proven operator with a track record of transforming complex operational challenges into scalable, practical, and elegant business processes
  • Systematic and detail-oriented approach to leadership, with a fierce commitment to quality, accuracy, and operational excellence
  • Deeply analytical and research-oriented, with the ability to digest intricate regulatory or technical guidance and seamlessly incorporate it into daily operations
  • Ability to manage and lead through ambiguity
  • Can-do attitude and stamina for tackling hard problems
  • High level of self-motivation and an ability to balance multiple priorities across initiatives
  • Results-oriented: you are energized by having an ambitious goal and the latitude to execute against it
  • Natural relationship builder and able to work well in a cross functional team environment
  • Experience managing multiple teams and vendors
  • Fast learner, can pick up new content/industries quickly in an extremely fast-paced tech environment
  • Proven organizational, communication, and leadership skills
  • Prior experience in Medicare Advantage risk adjustment, in particular RAPS and EDPS data submission and retrospective chart reviews preferred but not required.

Benefits

  • Employer sponsored health, dental and vision plan with low or no premium
  • Generous paid time off
  • $100 monthly mobile or internet stipend
  • Stock options for all employees
  • Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles
  • Parental leave program
  • 401K program
  • And more....

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