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Risk Adjustment Manager

| Waltham
A bit about us: 
Devoted Health is a new health care company looking to improve the lives of seniors in America. We are guided by a deep belief that every senior should be treated like we would treat a member of our own family: with loving care and a profound commitment to their health and well-being. With aging demographics and rising health costs, this is an industry and problem space that needs today’s best talent working on solutions with high integrity and a long term view. We will improve the lives of seniors by helping them navigate the health care system, by utilizing world-class technology and data to enable a simplified experience, by partnering with top providers for better health outcomes. We are building a stellar team to drive towards our starting point goal to launch a Medicare Advantage plan and clinical services in 2019.
Why Devoted:
Make a difference... a big difference. You will have the opportunity, in a unique and dynamic culture, to be a part of something incredibly meaningful. We’re a disruptive startup with an inspiring mission. Learn and grow alongside our world-class team of healthcare, technology, and data leaders, dedicated to building a health plan and clinical services that care for everyone like they were our own mothers or fathers. Our team and board members have decades of experience in health care entrepreneurship, data, technology, services, and policy. With their support, we look forward to building a health plan and clinical services that will give seniors easy access to the high-quality care they deserve. 
A bit more about this role: 
The Risk Adjustment Program Manager is responsible for the timely and accurate collection, flow and processing of data for risk adjustment activities for Devoted Health. The Manager will establish, monitor, and maintain the processes, systems and services that collect and process the data from claims, encounters, electronic medical records, medical record coding, and other supplemental data sources. Reporting and maintaining SOX compliance is also a responsibility of this position. This role acts as the risk adjustment program subject matter expert. The Risk Adjustment Program Manager works closely with other areas of health plan operations and programs, and ensures risk adjustment data operations are administered accurately, timely and in compliance with CMS regulations.

Role responsibility: 

  • Manage the Electronic Data Processing (EDPS) data submission process and ensure that all available data is accepted by CMS and manage the transition from RAPS to EDPS
  • Knowledge of regulations related to data submissions for Devoted Health
  • Knowledge of RAPS and 837I (5010) formats and file protocols
  • Demonstrated ability to complete complex tasks and data processing reliably on time
  • Implements coaching and training plans
  • Negotiates and maintains vendor contracts and relationships as needed
  • Monitors vendor progress and performance and works to improve vendor performance if needed
  • Assists with developing coding policies and plans long-term plan to use technology and other resources to provide more and better information to network providers
  • Coordinates and develops metrics related to risk adjustment operations to inform leadership on progress of activities and risk adjustment programs
  • Maintains knowledge of applicable current and proposed laws, regulations, and sub-regulatory guidance (e.g., CMS) applicable to Risk Adjustment specifically and general knowledge of Medicare Advantage requirements
  • Drafts and maintains policies and procedures, standard operating procedures, and work instructions
  • Actively researches and stays current with requirements from CMS to ensure that risk adjustment program is in compliance with government regulation
  • Escalate gaps in projects to senior leadership
  • Responsible for assisting leadership with implementation and oversight of risk adjustment and mechanism for projects

Attributes to success:

  • Excellent analytical and problem-solving skills
  • Ability to communicates to both internal and external clients on new developments
  • Enjoy engaging in the outlining of program development and management processes, manages the overall scoping, planning, business requirements gathering and delivery of risk adjustment program activities from idea inception to ongoing support and enhancement
  • Communicate with internal and external stakeholders - progress reporting and vendor management
  • Facilitate sharing of expertise by training other departments in support of risk adjustment program
  • Serves as a mentor for other team members to achieve scalability goals

Qualifications:

  • CPHQ certification preferred
  • 2+ years of experience in Risk Adjustment or related healthcare environment
  • Proven track record of managing partners / vendors 
  • Background in analytics, statistics, data management 
  • Proficiency with risk adjustment methodologies
  • Knowledge of coding, HCCs, risk adjustments concepts, medical record review project management, encounter data management, compliance audit concepts. 
  • Prior experience with CMS risk adjustment projects preferred.
  • Bachelor’s preferred
  • Experience with risk adjustment data validations or equivalent compliance audits

If you love running towards complex challenges and transforming them into solutions, if you want to make a potentially huge impact on many lives, and if you are looking for a disruptive startup with an inspiring and talented team, Devoted Health may be the place for you!

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Technology we use

  • Engineering
    • GolangLanguages
    • PythonLanguages
    • TypeScriptLanguages
    • ReactLibraries
    • recomposeLibraries
    • Apollo GraphQLLibraries
    • AngularJSFrameworks
    • gRPCFrameworks
    • AWSFrameworks
    • PostgreSQLDatabases
    • RedshiftDatabases

Location

Our sunny office is in the beautiful Watch Factory alongside the Charles River in Waltham. It's easily reachable by commuter train, bus, or bike.

What are Devoted Health Perks + Benefits

Devoted Health Benefits Overview

We offer bright, open office space with plenty of flexibility, awesome colleagues and a strong focus on our mission and supporting the work/life balance of all Devotees. We believe that taking care of ourselves will help us deliver the best possible service to our members.

We offer a free(100% employer paid) HMO Plan through Blue Cross Blue shield for our employees and their families. We also offer a PPO plan at a very limited cost.

Health Insurance & Wellness Benefits
Flexible Spending Account (FSA)
Dental Benefits
Fully company paid through Blue Cross Blue Shield
Vision Benefits
Fully company paid through Blue Cross Blue Shield
Health Insurance Benefits
We offer a free(100% employer paid) HMO Plan through Blue Cross Blue shield for our employees and their families. We also offer a PPO plan at a very limited cost.
Life Insurance
Offered through the Hartford
Wellness Programs
Wellness program where you can earn money back for healthy behavior along with an onsite gym and cross fit classes onsite
Onsite Gym
Yes, in our facility
Retirement & Stock Options Benefits
401(K)
Yes, we offer a 401K
Company Equity
Equity offered to all Devotees
Child Care & Parental Leave Benefits
Generous Parental Leave
We offer 3 months fully paid for maternity leave and 1 month paternity leave
Flexible Work Schedule
Family Medical Leave
Yes
Vacation & Time Off Benefits
Unlimited Vacation Policy
Generous PTO Polity
Generous PTO
Perks & Discounts
Casual Dress
We embrace the "bring your whole self to work" mantra and want folks to feel comfortable doing their best work
Company Outings
Company retreats, happy hours and team events
Stocked Kitchen
We offer healthy snacks including fresh fruit, bagels and cream cheese, popcorn, energy bars and dark chocolate.
Some Meals Provided
Free lunch weekly
Parking
Free parking onsite
Fitness Subsidies
BCBS reimburses up to 3 months of health club fees
Professional Development Benefits
Job Training & Conferences
We encourage and support our employees in continuing their educational endeavors.
Diversity Program
Devoted has a strong focus on building the most diverse and inclusive workforce we can. We won a 2018 NEVY award for diversity

Additional Perks + Benefits

The people at Devoted are drawn together with the common mission of making a material difference in the healthcare system as a whole and specifically in the lives of the members we serve. We are the type of company that supports employees as they move through the stages of their life while providing constant learning and opportunities for growth and change.

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