Job Details

ID #6136043
Estado Tennessee
Ciudad Franklin
Tipo de trabajo Full-time
Salario USD TBD TBD
Fuente PopHealthCare, LLC
Showed 2020-11-26
Fecha 2020-11-26
Fecha tope 2021-01-25
Categoría Etcétera
Crear un currículum vítae

Director, Revenue Analytics

Tennessee, Franklin, 37064 Franklin USA

Vacancy caducado!

Job Description

Job Summary:PopHealthCare has built an exceptional Revenue Analytics team to help forward-looking health plans succeed under new value-based care payment models. Risk adjustment is one of the most significant challenges facing these innovators. The Revenue Analytics team of experts in risk adjustment does it all - from data analytics & advanced modeling, to designing, presenting, and implementing industry-leading solutions. We are looking for a Director, Revenue Analytics to partner with this team to develop and maintain risk adjustment analytic capabilities.Success in this role comes from a combination of exceptional attention to detail and accuracy, top-notch data analysis and presentation skills, commitment to cross-functional teamwork, and an outstanding client service ethic.

Position Essential Functions:

  • Supports coordination of clinician chart audit activities and operational aspects of clinical chart reviews, including identifying and data mining patient lists.
  • Organizes and provides executive performance reporting and communication for any managed programs.
  • Supports implementation of programs designed to ensure all diagnosed codes and conditions are properly supported and submitted to CMS.
  • Integrates best practices and tools to improve operational efficiency, reduce costs, and increase customer satisfaction.
  • Develops and improves standard operating procedures.
  • Demonstrates excellent analytical and problem-solving skills.
  • Use strong data analysis skills (e.g., SAS/SQL/Excel) to producetimely and accurate reports and insights.
  • Participates in the discovery, evaluation, and solutioning of new clinical services.
  • Provides analytical support in understanding and evaluating cost and benefit of various business proposals, and the profitability of various service areas or line of business within the region for critical decision making.
  • Develops financial models to support various risk adjustment or performance initiative related decisions.
  • Communicates with systems development experts to design tools and applications to automate the fulfillment of repeat requests.
  • Effectively directs preparation of various financial analysis and data mining activities.

Qualifications

  • Bachelors' Degree in Biostatistics, Mathematics, Computer Science, Actuarial Science, or a closely related field of study.
  • 3-5 years minimum risk adjustment program coordination experience.
  • 5+ years health care experience.
  • Moderate SAS and/or SQL skills.
  • 5+ years’ experience producing risk adjustment analysis related to the Medicare Advantage, Medicaid, and/or ACA program.
  • Ability to provide narrative context of data analysis to a non-technical audience.
  • Experience producing financial models and payment forecasts.
  • Demonstrated commitment to delivering outstanding products and service that meet or exceed our client’s expectations.
  • Knowledge of regulations related to Medicare Advantage, Medicaid, and/or Commercial risk adjustment.
  • Knowledge of claim coding and payment methodology utilized in Medicare and Medicaid lines of business.
  • Ability to interact effectively with C-Level employees across the organization as well as with staff, clinicians, and management.
  • Ability to initiate and maintain cross-team relationships.
  • Excellent verbal and written communication skills.
  • Located in the Franklin, TN or Tempe, AZ areas or willingness to occasionally travel to either area for project and team meetings.

Preferred Requirements:

  • 1-3 years minimum management experience.
  • Background in supporting population health management and clinical informatics.

PopHealthCare is an equal opportunity/equal access employer fully committed to achieving a diverse workforce

Additional Information

All your information will be kept confidential according to EEO guidelines.

Vacancy caducado!

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