About The Role

The Director of Risk Adjustment plays a key role in overseeing the technical and operational dimensions of the Risk Adjustment function within the Population Health team. Responsible for collaborating with internal and external partners, the Director of Risk Adjustment will establish, monitor, and maintain processes, IT systems, and services related to data collection and processing from claims, encounters, electronic medical records, medical record coding, and annual wellness/comprehensive visits with FQHCs. Additionally, the role involves the critical responsibility of building and monitoring audit functions to ensure the accuracy and effectiveness of risk adjustment processes. The Director of Risk Adjustment will also provide leadership and guidance to a dedicated team, fostering a collaborative and innovative environment to achieve the department's goals while staying abreast of industry trends and regulatory changes to implement best practices.

*At this time, Yuvo Health is not able to provide visa sponsorship or work authorization support.

What You'll Do

• Responsible for the development and execution of an overall Risk Adjustment Strategy while providing leadership and participation in risk meetings as an active member of the team, to discuss policy, strategy, implementation, administration, goals, progress, and improvement.
• As an integral member of the Population health team, contribute to department goals, KPIs, collaborations and strategies.
• Lead in the development and day-to-day oversight of Yuvo’s risk adjustment function.
• Act as the key stakeholder and subject matter expert for risk adjustment and diagnosis documentation across the organization.
• Facilitates the development of tracking and monitoring mechanisms for all projects.
• Develop and manage company-wide policies for risk adjustment and coding practice to ensure clinical documentation integrity.
• Creates planning timelines and resource requirements; works cross-functionally to determine dollars at risk.
• Oversight of day-to-day coding team tasks to support accurate and complete coding while enabling our Federally Qualified Health Center partners.
• Collaborates with the team on prospective and retrospective review programs.
• Partners with compliance and finance to ensure compliance with CMS rules.
• Analyze Yuvo’s Independent Practice Association performance against risk targets, and establish near-term and long-term plans to address emerging issues.
• Develop ongoing performance improvement projects based on needs of internal and external initiatives, and in line with national best practice.
• Work closely with product, technology, analytics, and operations teams to establish and streamline effective provider engagement and reporting tools.
• Creates a long-term plan to use technology and other resources to provide more and better information to FQHCs.
• Actively participates with FQHCs to give training and feedback on risk adjustment.
• Work collaboratively with FQHCs to ensure all risk adjustment data submission processes are ensuring revenue integrity.
• Responsible to comply with State Medicaid and CMS regulations with respect to Risk Adjustment rules.
• Contributes to risk adjustment functions related to Concurrent Review, Care Management, Quality Improvement, Government Contracts, Compliance, and Provider Engagement as outlined by the Senior Leadership and dictated by FQHC needs.
• Collaborate with Population Health Team to set achievable risk targets for Value Based Care contracts
• Contributes to the achievement of Yuvo's goals and objectives by performing other duties as assigned.

What You'll Bring

• Background in supporting risk adjustment activities and clinical informatics in provider or health plan environments
• Leadership experience overseeing a team
• Proficiency with all other risk adjustment methodologies
• Knowledge of coding, HCCs, risk adjustments concepts, medical record review project management, encounter data management, compliance audit concepts
• Knowledge of change management
• Knowledge of regulations related to data submission for Medicaid, Medicare Advantage and Marketplace risk adjustment
• Strong problem-solving ability and a customer-centric focus
• Exceptional leadership, communication, and stakeholder management skills
• Comfort operating in a high-growth, early-stage organization and managing the ambiguity and messiness that can come with working in this environment.
• Thrives in a collaborative, cross-functional team environment centered around diversity, acceptance, and belonging
• A culture champion for the organization and a tireless advocate for your team

We'd Love To See

• Strong analytics and/or finance background
• Knowledge of Lean, 6 Sigma, and 5S technologies
• Highly organized with a strong attention to detail

What We Value

• Desire to learn and grow
• Bias towards action
• Team-oriented attitude, you derive joy from seeing others succeed
• Enthusiasm for, and interest in, health equity and innovation

Benefits

Base Salary Range: $140,000 - $165,000

Additionally, Yuvo is proud to offer the following:

• Unlimited vacation leave
• Paid parental leave
• Competitive medical, dental, and vision insurance
• $500 reimbursement for reasonable work equipment in the first year of employment
• Stock options