Director of Risk Adjustment and Coding Operations
Holy Cross

Job Info

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Employment Type:Full timeShift:

Description:
**Must live in the South Florida area - this is not a remote position**

Roles and Responsibilities

• Oversee, coordinate, or perform data mining and data-driven analysis to forecast/evaluate 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 leaders

Education & Qualifications

• South Florida area candidates or candidates willing to relocate
• Bachelor's degree from a four-year college required
• RHIA/RHIT required credentials preferred
• Specialization in building business units to become more effective and efficient while fostering a team environment
• 7+ years' experience working in a value-based provider group, health plan, and/or vendor contracting with health plans providing annual wellness/risk adjustment services
• 5+ years' experience in a leadership role in a capacity developing and implementing risk adjustment, coding, wellness assessment, and analytics programs and processes
• Expertise in Medicare programs and regulations including fraud and abuse and Medicare Hierarchical Condition Coding Risk Adjustment
• Excellent analysis and presentation skills
• Experience working in high-growth environment preferred
• Valid driver's license

Position Highlights and Benefits

• Comprehensive benefit packages available, including medical, dental, vision, paid time off, 403B, and education assistance
• We serve together in the spirit of the Gospel as a compassionate and transforming healing presence within our communities
• We live and breathe our guiding behaviors: we support each other in serving, we communicate openly, honestly, respectfully, and directly, we are fully present, we are all accountable, we trust and assume goodness in intentions, and we are continuous learners communicate openly, honestly, respectfully, and directly, we are fully present, we are all accountable, we trust and assume goodness in intentions, and we are continuous learners

Ministry/Facility Information:

• Holy Cross Hospital in Fort Lauderdale, Florida is a full-service, non-profit Catholic hospital, sponsored by the Sisters of Mercy and a member of Trinity Health.
• We are committed to providing compassionate and holistic person-centered care.
• We are the only Catholic hospital in Broward and Palm Beach counties and are not for profit. We are part of Trinity Health, one of the largest multi-institutional Catholic health care delivery systems in the nation. Together, we serve people and communities in 21 states from coast to coast, providing nearly 2.8 million visits annually.
• Comprehensive benefits that start on your first day of work
• Retirement savings program with employer matching
  

Legal Info

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

Our Commitment to Diversity and Inclusion

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.

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