Vice President, Risk Adjustment and Data Analytics (RADA)
February 1, 2018
Throughout , California
Full Time - Experienced
Hospital, Public and Private
4 Year Degree
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Vice President, Risk Adjustment and Data Analytics (RADA)
In this role, you will be accountable for data integrity to support accurate payment and associated risk adjustment, encounter, and other data oversight, monitoring, and analytics in five general functions and key accountabilities which include: oversight and monitoring, financial risk and operations management, strategic planning, change management, and staff development. You will be responsible for end-to-end strategy deployment and monitoring of all risk adjustment and other data and analytic activities for the enterprise to support accurate payment. You will be involved in strategic leadership, organizational direction, as well as operational support for risk adjusted and payment integrity initiatives. Other responsibilities include developing, implementing, and overseeing the program wide data integrity initiative as well as ensuring that risk adjustment (and potentially other revenue) programs are compliant with Centers for Medicare and Medicaid Services (CMS) and state and federal regulatory requirements; establishing and executing strategy and integration of risk adjustment and encounter data submission for all lines of business (Medicare Advantage, Commercial Exchanges, and Cost Share Reduction); ensuring cost effective oversight for the entire life cycle of risk scores from patient assessment to CMS submission and ultimately payment, including the establishment and verification of policies and procedures to ensure complete, accurate, and truthful data to CMS. You will also serve as the executive for Cost Share Reduction (CSR) reconciliation.
Day-to-day duties include oversight of risk adjustment operations, analytics, and reporting – this includes data production and operational analytics, risk adjustment systems, ACA and Medicare risk adjustment and CSR submission, monitoring, analysis, reporting, and forecasting of risk adjustment, encounter, and other required data for risk score calculation and payment integrity; interacting with regional, functional, and national executive partners to align work and clear barriers as necessary; identifying and following through on ways to enhance completeness and accuracy of the data submitted – this includes executing on data integrity projects and analyses to support performance and submission efforts; and leading the assessment of performance and associated analysis, forecasting/financial planning, end-to-end data reconciliation, and error management relating to risk adjustment. In addition, you will interact with Government Relations to analyze and review proposed legislation and regulatory notices in relation to risk adjustment impact and for developing procedures and policies established in accordance with government and other appropriate regulations to support Sarbanes Oxley and Model Audit Rule compliance.
At least ten years of comprehensive experience leading financial activities of a multi-faceted health plan, health care system, or multi-service provider setting
At least eight years of comprehensive risk adjustment experience
A bachelor’s degree in business administration, economics, finance, accounting, public health, or other quantitative field
MBA, MPH, or CPA preferred
Coding and/or medical terminology a plus
Management experience in accounting, finance, business, or a related field
Experience with forecasting, financial analysis, and budgeting techniques
Leadership or project management experience in achieving results through others in a complex matrixed organization
Leadership experience working with regulatory agencies and their contract auditors
Thorough knowledge of Centers for Medicare and Medicaid Services (CMS) Regulatory Reimbursement and Compliance Regulations for Medicare Advantage
Familiarity with the requirements of SOX and Model Audit Rules guidelines and programs
The ability to build teams, lead professionals, and manage through influence and cooperation
Orientation toward goal-setting and performance management to achieve bottom-line results
Excellent interpersonal, communication, and presentation skills
The ability to understand and assess complex market conditions and recommend necessary cost structure improvements or revenue growth opportunities
The ability to build effective partnerships and influence other leaders
The ability to consistently demonstrate integrity, prudence, high energy, initiative, and self-confidence
For immediate consideration, please visit http://kp.org/careers for complete qualifications and job submission details, referencing job number 662446.
External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.
This position supports Kaiser Permanente’s code of conduct and compliance by adhering to all laws and regulations, accreditation and licensure requirements, and internal policies and procedures.
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