Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day. Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015. The Vice President Risk Adjustment and Data Analytics works closely and collaboratively with Vice Presidents in the Health Plan and leaders across the organization to oversee the design, development, implementation, and execution of compliant risk adjustment strategies, programs, and initiatives for Martin’s Point Health Care, including but not limited to its Generations Advantage Medicare Advantage product portfolio and to define and deliver on our health plan data analytics strategy and structure. The VP will create and lead the organization’s risk adjustment strategy utilizing CMS HCC and CPDS models.
- Lead the health plan in the design and development of risk adjustment strategies to support the achievement of revenue projections for Generations Advantage; forecast revenue for Generations Advantage in concert with CFO and Finance leadership.
- Lead the risk adjustment and data analytics teams to ensure that the programs and initiatives are effective, efficient, and contribute to the overall risk adjustment score outcomes.
- Develop strong, collaborative relationships across the organization and with our provider partners.
- Ensure that the Risk Adjustment and Data Analytics teams have the appropriate skills and expertise to meet the ongoing business initiatives; create future leaders and staff bench strength within the team; and strategically align resources by continuously planning and organizing to meet initiatives.
- Lead teams to manage resources to maximize the return on investment in internal and external risk adjustment programs
- Effectively develop, track, report and communicate operational metrics to track the department and organizational performance against prescribed goals.
- Collaborate with senior management to develop strategies and tactics to improve the accuracy of risk scores and reduce payment error risk.
- Evaluate and create metrics for established operations, tracking performance, and resolving deficits.
- Ensure the accuracy and completeness of data submissions and risk scores for the health plan (including chronic re-coding for existing members, new member coding, etc.).
- Primary contact for vendor contracts supporting risk adjustment efforts including contract negotiation, setting goals and tracking performance, and analyzing program ROI; determine which activities should be outsourced or insourced.
- Accountable for risk adjustment audits, including RADV for all Medicare Advantage plans.
- Proactively and aggressively identify and resolve data quality issues and maintain a robust measurement and reporting audit process for routine reports and measures.
- Provide mentoring to health plan analysts and data architects.
- Bachelor’s Degree in Healthcare Administration, Business Administration, or related field: Master’s Degree preferred
- 10+ years of experience in managed care operations management including experience in a senior leadership role and with Medicare Risk adjustment
We are an equal opportunity/affirmative action employer.
Do you have a question about careers at Martin’s Point Health Care? Contact us at: email@example.com