Manager, Medicare and Medicaid Risk Adjustment

Site: Mass General Brigham Health Plan Holding Company, Inc.   Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.

  Job Summary Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are at the forefront of transformation with one of the world’s leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage.

Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills.

We are pleased to offer competitive salaries and a benefits package with flexible work options, career growth opportunities, and much more.

Responsible for overseeing and managing the risk adjustment program for Medicare and Medicaid within MGB Health Plan. This role leads and develops a team, collaborates with cross-functional teams to optimize risk adjustment strategy and operations, and ensures accurate documentation and coding of patient conditions.

Essential Functions -Lead risk adjustment strategy and operations. -Directly manage and develop a team (including hiring, performance management, and coaching). -Develop and present analytics that communicate ongoing financial performance. -Lead risk adjustment operational work across the entire lifecycle of the payment process. -Develop content and strategies for provider training, education, and medical management. -Evaluates data quality of internal and external datasets. -Work with vendors to help negotiate new or existing contracts.   Qualifications

Education Bachelor's Degree required; experience can be considered in lieu of a degree

Experience At least 5-7 years of experience in managing risk adjustment programs in a healthcare setting, including direct team leadership, required

Knowledge, Skills, and Abilities In-depth knowledge of risk adjustment methodologies and healthcare coding guidelines for Medicare and Medicaid lines of business. Familiarity with healthcare regulations and compliance requirements related to risk adjustment. Strong analytical and problem-solving skills. Excellent communication skills to collaborate effectively with various stakeholders. Proven ability to manage, coach, and develop direct reports. Strong problem-solving skills to address coding and documentation challenges and develop corrective action.

  Additional Job Details (if applicable)

Working Conditions This is a remote role that can be done from most US states with a strong preference for local candidates who could attend occassional in-person meetings This is a Monday-Friday role with standard business hours (in Eastern time) ​

  Remote Type

Remote   Work Location

399 Revolution Drive   Scheduled Weekly Hours

40   Employee Type

Regular   Work Shift

Day (United States of America)

  Pay Range $99,465.60 - $144,643.20/Annual   Grade 8   At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.   EEO Statement:

8925 Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.   Mass General Brigham Competency Framework At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.