Program Manager, Risk Adjustment Operations and Analytics
AllWays Health Partners

Job Info

For over 30 years, AllWays Health Partners has delivered value to our members and worked to improve access to care and coverage. As a member of Mass General Brigham, AllWays is a health plan at the forefront of innovation, advancing a highly integrated model of value-based care with one of the world's leading health care systems. Together, we are transforming the customer experience, keeping our members and patients at the center of everything we do. Bring your unique talents and join us as we strive to create a world where all people live healthier lives.

This role requires interacting and influencing internal and external stakeholders to ensure project success. The Program Manager will follow and document all CMS and MassHealth risk related activites and ensure the company is positioned to meet any new requirements; as well as, develop ideas that enhances our company's competitive position for risk adjustment.

ESSENTIAL FUNCTIONS
• Lead all internal and external risk adjusted projects
• Follows all CMS calls and presentations to ensure compliance and identify new ideas and strategies for improving risk adjustment
• Manages all vendor relationships and helps negotiate any new or existing contracts
• Develop and present complex analytics that communicate ongoing financial performance from internally custom built and externally vendor built sources.
• Communicate directly with C Suite as needed for risk adjustment analytics.
• Participate in all audits
• Develops strategies for provider training, education and medical management
• Evaluates data quality of internal and external datasets
• Anticipates and meets, or exceeds, internal and/or external customer expectations and requirements; establishes and maintains effective relationships with customers and gains their trust and respect. • Hold self and others accountable to meet commitments.
• Build strong customer relationships and deliver solutions that meet customer expectations; establish and maintain effective customer relationships - both internal as well as external.

• Other duties as assigned with or without accommodation.

WORKING CONDITIONS AND PHYSICAL EFFORT
• Work is normally performed in a typical office work environment.

Qualifications
KNOWLEDGE AND EDUCATION

Required:
• Bachelor's Degree or the equivalent combination of training and experience, plus four years of related experience.

Preferred/Desired:
• Master's degree in related field
• Medical coding certification or equivalent experience

EXPERIENCE

Required:
• 5 plus years of experience in healthcare reporting of healthcare data analysis using SQL and/or SAS
• Advanced Excel
• 2 plus years leading complex projects
• Previous experience presenting analytics to executive level
• Knowledge of HHS Commercial Risk Adjustment and ACA
• Knowledge of MassHealth risk adjustment and DxCG
Preferred/Desired:
• Previous experience with CMS risk adjustment audits (RADV)

SKILLS/COMPETENCIES

• Strong leadership skills. Able to work with minimal supervision
• Strong analytical skills
• Excellent verbal and written communication skills; outstanding interpersonal skills; the ability to relate positively with individuals at all levels both internally at AllWays Health Partners and externally with providers/consultants/vendors
• Ability to learn new software tools and reporting methodologies quickly
• Creative, flexible, self-directed, and self-motivated with sound judgment
• Accountable for delivering high quality work
• Organizational and project management skills to manage projects effectively; ability to manage multiple projects simultaneously
• Demonstrate AllWays Health Partners Core Values of Accountability, Service Excellence, Quality Care, Diversity, and forging strong Relationships.
• Respect the talent and unique contribution of every individual, culture and ethnic group and treat all people in a fair and equitable manner.
• Exercise self-awareness; monitor impact on others; is receptive to and seek out feedback; use self-discipline to adjust to feedback.
• Accountable for delivering high quality work. Act with a clear sense of ownership.

INDEPENDENT ACTION
The majority of work is conducted with minimal direction or supervision of the Manager or Director. The Program Manager develops new ideas and processes to improve our financial performance and help more accurately predict our future financial state

ORGANIZATIONAL RELATIONSHIPS/SCOPE

The Program Manager works collaboratively with staff, managers, and directors across the entire organization. In addition, the Analyst will interact with internal executives and externally, with individuals from our provider network and contracted consultants/vendors.

EEO Statement
AllWays Health Partners mission targets a diverse population and our employees are just as diverse. As an equal opportunity employer, AllWays Health Partners recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives, and backgrounds.

DISCLAIMER
The above statements are intended to describe the general nature and complexity of the work being performed by personnel assigned to this classification, and do not represent an exhaustive list of all tasks, duties, and responsibilities required of personnel assigned to this position.