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Manager Risk Adjustment ICP - Clinical Integration

Requisition ID:

21161048

Business Unit:

Hartford HealthCare Corp.

Location:

Hartford, CT

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Description

Job Schedule: Full Time
Standard Hours: 40
Job Shift: Shift 1
Shift Details: Business/operation hours, however an occasional evening may be required for provider-facing meetings

Work where every moment matters.

Every day, almost 35,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut’s most comprehensive healthcare network.

The creation of the HHC System Support Office recognizes the work of a large and growing group of employees whose responsibilities are continually evolving so that we and our departments now work on behalf of the system as a whole, rather than a single member organization.
With the creation of our new umbrella organization we now have our own identity with a unique payroll, benefits, performance management system, service recognition programs and other common practices across the system.

JOB SUMMARY:

The ICP Risk Adjustment Program Manager will be responsible for the planning, building and implementation of a Risk Adjustment Coding Program.  This role will design, develop, implement and manage a comprehensive Hierarchical Condition Category/Risk Adjustment Factor program.  Responsible for building and managing a team of professionals to drive the work required to ensure complete and accurate coding across the ICP organization.

Key Areas of Responsibility:

  1. Overall responsibility for risk adjustment, which includes Hierarchical Condition Coding (HCC) or other risk adjusted revenue programs, to ensure complete and accurate revenue for Medicare Advantage and MSSP. Directs the activities of staff accountable for complete and accurate risk adjusted revenue through the submission and analysis of medical and pharmacy claims, prospective and retrospective review of data and related functional activities to support ICP and HHC. Participates in the planning, development and standardization of reimbursement processes throughout the enterprise to assure the accurate capture of diagnoses codes, collaborates with IT, ICP members and CMS to ensure that data is effectively transmitted to appropriate regulatory agencies and accepted with minimal errors
  2. Build a HCC/RAF program that includes
    1. Data mining strategies for members covered under risk-based models (i.e. Medicare Advantage Plans)
    2. Developing organization-wide data collection methodology and an effective HCC/RAF coding program
    3. Standardization of HCC/RAF workflows, including monitoring and improvement of error rates and timely submission
    4. Provider and practice education and performance monitoring and improvement
    5. Work queue and quality/coding program direct coding management (expectation for this position to be a working manager role)
  3. Develop and high functioning staff by recruiting, selecting, orienting, and training employees
  4. Develop a training program for ICP providers and staff to ensure valid HCC documentation
    1. Coordinate network provider and staff training required to address knowledge gaps and new HCC/diagnoses identified as opportunities
    2. Make recommendations to providers/practices as to how to best support the HCC/RAF optimization strategies
    3. Develop and strengthen relationships with provider partners to achieve improvements in risk adjustment program participation and data validation
  5. Present HCC/RAF performance results and findings regularly to physicians and practice, including the overall HCC/RAF score, improvement strategies and tactics
  6. Serve as risk adjustment coding subject matter expert for Medicare plans and corporate HCC/RAF outreach teams
  7. Reports status of risk scores on monthly basis to VP
  8. Gain professional and technical knowledge by attending educational workshops, reviewing professional publications, establishing personal networks and participating in professional societies.

WORKING RELATIONSHIPS:

Nature of Supervision:

Receives overall supervision from ICP Operations Manager and ICP, VP, Business Operations

Internal:

Interacts with ICP leadership and staff

Interacts with HHCMG leadership

Interacts with ICP providers members and office staff

External:

Interacts with JV Partners, Payers, Vendors

Qualifications

QUALIFICATIONS:

Education:

  • Associates Degree, Bachelor’s or Higher preferred

Experience:

  • At least 1 year of supervisory/lead coding team experience

Licensure, Certification, Registration

  • Must be a Certified Risk Coder. CPC or CRC preferred

Knowledge, Skills and Ability Requirements:

•              Excellent communication and interpersonal skills

•              Ability to understand and convey complex information to many different kinds of people is an absolute requirement with demonstrated ability to work as a member of a team

•              Ability to innovate to achieve the organization’s goals

•              Strong business, analytical and project management skills; a good understanding of revenue cycle management, health care finance and processes (including clinical workflows)

•              Excellent analytical and leadership skills

•              Experience in managing staff, including staff development, coaching/mentoring, performance reviews, and administration of guidelines

•              Must be organized and detail oriented with a strong bias for follow-up and problem resolution

•              Proven ability to be a team player

•              Excellent oral and written communication skills

•              Relies on extensive experience and judgment to plan and accomplish goals

•              Proven leadership skills in physician practice relationships that include influencing, efficiency, collaboration, candor, and openness with a focus on results

•              Proficient with MS Word, Excel, PowerPoint, and computer user interfaces

We take great care of careers.

With locations around the state, Hartford HealthCare offers exciting opportunities for career development and growth. Here, you are part of an organization on the cutting edge – helping to bring new technologies, breakthrough treatments and community education to countless men, women and children. We know that a thriving organization starts with thriving employees-- we provide a competitive benefits program designed to ensure work/life balance. Every moment matters. And this is your moment.

 
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