Associate Vice President, Risk Adjustment

Associate Vice President, Risk AdjustmentAt Altais, we're on a mission to improve the healthcare experience for everyone—starting with the people who deliver it. We help physicians focus more on patient care and less on paperwork through smarter technology, purpose-built tools, and a team-based model of care.Our network includes Brown & Toland Physicians, Altais Medical Group, and Family Care Specialists. Together, we're building a more connected, physician-first healthcare system.The Associate Vice President, Risk Adjustment is responsible for ensuring the organization has a comprehensive, efficient and compliant documentation integrity program (risk adjustment and HEDIS/Stars Quality measure documentation). Works directly with clinicians, certified coders, IT, enterprise analytics, network management and physicians. Owns accountability for ensuring our members' medical record is complete, accurate and represents accurate member conditions. This role will work closely with the Quality/Accreditation teams, Customer Service and Call Center Teams, Provider Services Team, Nurse Practitioners, and Clinical Program Teams.You will focus on:Applies in-depth knowledge of risk adjustment methodology to partner with key stakeholders in improving outcomesOversees programs aimed at monitoring, oversight and compliance for coding accuracyProvides leadership and direct support for medical documentation integrity programs across all lines of businessEnsures that documentation integrity programs comply with all applicable federal and state guidelinesDeploys programs to ensure members' medical record is complete, accurate and represents accurate member conditionsLeads the design of a high performing, compliant documentation integrity program including leading analytical and operational teams for successful delivery of programs including:Deploying a comprehensive coding and documentation program,Retrospective and prospective chart review,Abstraction and encounter submissionProvider profiling, engagement and education programsAnnual Health Assessment programsEnsures the appropriate strategy, tactics and data capture processes are in place and in compliance with state and federal regulationsParticipates and manages all regulatory auditsDevelops and implements provider education strategies and tools, monitors provider performance, develops improvement plans and assists physicians/care teams to ensure patients are accurately assessed for medical conditionsEngages with enterprise functional areas to ensure Members with complex/chronic conditions are referred to care management programsComposes and distributes education materials to physicians and vendors to aid the collection of complete and accurate member profile documentationStays informed of all risk related program requirements from CMS and develop implementation strategies to CMS requirementsOversees implementation of documentation integrity analytics platform and related technological solutions, including Epic integrated toolsCreates a culture focused on ComplianceProvides ongoing updates and policy modifications distributed by CMSServes to alert relevant stakeholders and propose new operational policy/processes to comply with regulatory mandatesPerforms management responsibilities including hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity; has budgetary responsibility and authorityThe Skills, Experience & Education You BringBachelor's Degree10 or more years related experience including:5 + years of experience in Managed Care, large medical group / IPA, Payer Provider Health Plan, Health system management.5 + years of experience in risk adjustment and HEDIS/STARS (Medicare Advantage/commercial).5 + years of experience with Chart Review, In Home assessment, Provider education, Prospective programs and encounter submissions; knowledge of billing rules and systems6 years of management experience5 years of demonstrated experience with reporting and analytical tools (power BI, Tableau, etc)Risk Adjustment experience in Managed Care, large medical group / IPA, Payer Provider Health Plan, Health system management.Knowledge within RAF markets (Medicare Advantage/commercial).HEDIS/STARS data abstraction and reporting experience in Managed Care, large medical group / IPA, Payer Provider Health Plan, Health system management.Chart Review, Annual Health Assessment (AHA/AWV), Provider education, Prospective programs and encounter submissions; knowledge of billing rules and systemsManagement experience and ability to be a servant leader who rolls up their sleeves to both do the work, coach the team, and be a strategic thinker to drive the program forwardDeep analytical skills to leveraging data to formulate insights and drive decisions. This includes manipulating and understanding data to craft data-driven messages, as well as thinking of new ways to draw insights from data.Use data to explain the why and hold other leaders accountable.Strong skills in influencing without authorityExpert at building relationships with a broad range of internal and external stakeholders.The Base Salary for this position is $169,950 - $225,000/yearIn addition, we provide a competitive compensation package that recognizes your experience, credentials, and education alongside a robust benefits program to meet your needs.Excellent medical, vision, and dental coverage401k savings plan with a company matchFlexible time off and 9 Paid HolidaysThis position will also be eligible to participate in our annual bonus programAltais values the contribution each Team Member brings to our organization. Final determination of a successful candidate's starting pay will vary based on several factors, including, but not limited to education and experience within the job or the industry. The pay scale listed for this position is generally for candidates that meet the specified qualifications and requirements listed on this job description. Additional pay may be determined for those candidates that exceed these specified qualifications and requirements. We provide a competitive compensation package that recognizes your experience, credentials, and education alongside a robust benefits program to meet your needs.The anticipated pay range for this role is listed in our salary posting for transparency but may vary based on factors including the candidate's qualifications, skills, and experience. This position will also be eligible to participate in our annual bonus program.Altais and its subsidiaries and affiliates are committed to protecting the privacy and security of the personal information you provide to us. Please refer to our 'CPRA Privacy Notice for California Employees and Applicants' to learn how we collect and process your personal information when you apply for a role with us.External hires must pass a background check/drug screen. Qualified applicants with arrest records 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 regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.