Providence Associate Vice President, Risk Adjustment in Beaverton, Oregon
The Associate Vice President (AVP) of Risk Adjustment and Coding will be based in the Portland/Beaverton, OR area. They will be responsible for the oversight of all risk adjustment activities pertinent to Providence Health Plan and AYIN business affiliates. The AVP plays a critical role in the development and execution of business strategy and compliance, overseeing the development, implementation and execution of risk adjustment strategy for the company. This includes risk adjustment program design for potential AYIN MSO clients. The AVP is responsible to work collaboratively with our PSJH partners at both the provider and population health division pertinent to all risk related activities. The AVP will be an advocacy voice representing Providence Health Plan to governmental agencies, and a contributing voice within the industry (i.e. AHIP, Health Alliance and related work groups) within work groups and formal presentations.
The Associate Vice President, Risk Adjustment will:
Be required to work in a matrixed environment and responsible for all Risk Adjustment related activities to support the PSJH family including goal setting, business planning and contracting efforts.
Be responsible for managing direct and indirect staff within the Risk Adjustment department:
Set team direction, resolve problems and provide guidance to members of team.
Design annual coding programs including but not limited to: physician outreach, physician-education, goal setting, and forecasting, plus maintain a robust quality control program for coding accuracy.
Provides oversight for nurse practitioner and in home assessment programs.
Monitor productivity and implement solutions to optimize coding department and vendor productivity Attend inter-departmental meetings related to HCC coding/RAF score calculations.
Function as key point person within Health Plan.
Be the Primary Accountable for vendor Contracts to support risk adjustment efforts including contract negotiation, setting goals and tracking performance and analyzing ROI.
Actively manage and optimize the end-to-end risk adjustment processes for Providence Health Plan and its delegated provider entities. Identify risk and opportunities associated with current processes.
Analyze business process information (e.g., metrics; analytics to identify key issues, trends, and potential root causes (e.g., training issues, lack of understanding by user community) that point to improvement opportunities.
Oversee, coordinate, or perform data mining and data driven analytics to forecast/evaluate the performance of the risk adjustment program and refine annual risk adjustment strategies to achieve optimal performance. Incorporate data-driven analysis into the risk adjustment process.
Monitor risk adjustment submissions with encounter data team. Compare expected revenue and proactively address gaps in data submissions and impacts to forecasting and budgets.
Adapt departmental plans and priorities to address business and operational challenges.
Required experience/education for this position include:
Bachelor’s Degree in Health Information Management or equivalent education/experience
RHIT Certification or APC Certification
Five (5) years of management experience of staff and major Project Initiatives
Five (5) years of management experience specific to risk adjustment
Five (5) years of experience in a healthcare related (clinical setting or medical insurance is required)
Demonstrated Proficiency in detailed software such as Microsoft Office, Word, Excel, Access, Adobe PDF, and similar workflow applications
Proficiency with the risk adjustment models of CMS, HHS, Medicaid and Exchange
Extensive knowledge of coding guidelines, regulations and compliance related issues related to Medicare, Medicaid and Commercial programs
Ability to effectively manage multiple caregiver teams and high risk priorities, including organizing operational functions, manage projects, improve the efficiency of work flows, perform basic financial analysis, and ensure staff and contractors are adequately trained to perform the work assigned them
Proficiency with diagnostic coding and how it relates to the Medicare Risk Adjustment Data submissions, claims submissions and claims payments
Proficiency in all coding applications such as CPT, HCPCS, ICD-10, and related coding guidelines and regulations
Extensive knowledge of the technology required to input, process, and transport risk related information
Knowledge of health insurance and health insurance billing systems
Expertise with computer software including spreadsheets, PowerPoint, Word, Excel, Access and project management programs
Ability to work in a close advisory role and/or as a team member with several departments/work units within Health Plan and with external providers)
Excellent oral and written communications skills
Demonstrated management and facilitation skills
Strong analytical and mathematical skills.
For information on our comprehensive range of benefits, visit:
As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Leadership
Req ID: 289213