Risk Adjustment Operations Lead, Remote
Aledade
Remote
operations
lead
remote
health
data
operations
healthcare
team
medical
patients
expert
stratification
cms
March 7, 2023
Aledade
Bethesda, Maryland
Aledade, Inc. is actively recruiting for a Risk Adjustment Operations Lead who has a proven track record of success.
We are looking for individuals who genuinely believe that Aledade s model of physician-led ACOs can improve quality and lower cost. This role can be based out of Bethesda, MD or work remotely anywhere within the US.
Responsibilities:
- Act as the subject matter expert and senior lead for risk adjustment operations on Aledade s Risk Stratification team, reporting to the Vice President of Risk Stratification
Oversee Aledade s risk adjustment operations and related data submissions pipeline, supporting complete and accurate payor and/or CMS acceptance of Aledade partner practice s risk adjustment data, from initial documentation at point of care through payor acceptance and validation
Own and document risk adjustment operations workflows and data submissions policies, in collaboration with internal Aledade stakeholders
Collaborate with Aledade Business Intelligence team members to build and refine KPI reporting mechanisms related to risk adjustment operations, as well as prioritize contracts & practices for data resubmission efforts
Inform broader Aledade Risk Stratification initiatives and programs (including clinical documentation integrity and diagnosis suspecting) in role as subject matter expert on risk adjustment operations
Serve as technical expert in collaborations with internal and external partners, including health plans and vendors, to research and identify operational requirements, data needs and transfer / ingestion approaches, and potential risks
Educate team members regarding risk adjustment methodologies and operational processes
Skills, Knowledge, Abilities Requirements:
In-depth knowledge of Medicare Advantage and Medicare Shared Savings Program payment structures and risk adjustment processes required
Strong understanding of the CMS-HCC risk adjustment model required
Familiarity with the HHS-HCC risk adjustment model and other risk adjustment models strongly preferred
Familiarity working with medical records and claims data, CMS data submission systems (RAPS and EDPS), and widely-used data reports and files used by risk adjustment teams, including MAO-002s and MAO-004s, required
Proficient Excel and/or Google Sheets skills required
Strong interpersonal and communication skills, including experience with complex stakeholder management
Experience Requirements:
- 4+ years of risk adjustment experience required in a programmatic role (e.g., in an analyst, operator, or management capacity, rather than as a biller or coder), preferably at at value-based care company, health system, or health plan
6+ years of healthcare experience preferred
Education Requirements:
- Bachelor's degree in Health Care / Health Administration, Economics, Business, Health Care, or a related field (or equivalent experience) required
All prospective hires will be required to demonstrate that they have been fully vaccinated, including booster shots, against COVID-19 with a COVID-19 vaccine for which the U.S. Food and Drug Administration has issued a license or an Emergency Use Authorization prior to mutually-agreed upon start date at Aledade, unless they qualify for a medical or religious accommodation to this vaccination requirement.
If you are passionate about transforming the healthcare system into one that best serves the needs of patients, doctors, and society, we d love for you to join us!
Who We Are:
Aledade is a leader in population health that is using innovative, value based solutions to transform the way physicians interact with their patients. We are on a mission to change healthcare for the better and solve complex problems within the healthcare system.
We follow the simple but radical idea that Aledade only succeeds when our partner practices succeed. From our cutting-edge technology platform to practice transformation services, we provide physicians with everything they need to create and run an accountable care organization (ACO), revamping the way they practice and getting them back to where they should be: quarterbacking their patients health care!
Our customized solutions help clinicians in communities across America preserve their autonomy, deliver better care to their patients, reduce overall costs, and keep independent physician practices flourishing.
What Does This Mean for You?
At Aledade, you will be part of a creative culture that is driven by a passion for tackling complex issues with respect, open-mindedness, and a desire to learn. You will work with team members that bring a wide range of experiences, interests, backgrounds, beliefs, and achievements to their work, united by a shared passion for public health and a commitment to the Aledade mission.
We ve recently been recognized as a Top Workplace by The Washington Post, Best Workplace in HealthCare & Biopharma, Top 100 Best Small & Medium Workplaces, Glassdoor Best Places to Work, a Best and Brightest Companies to Work for in the Nation, a Tech Tribune 10 Best Tech Startups in Maryland and Bethesda, Best Tech for Good, Best Workplaces for Millennials, Best Workplaces for Women, Best Workplaces for Parents, Top Workplaces USA, and a Healthcare Industry Top Workplace.
That s because the things that matter to you also matter to us!
In addition to time off to support work-life balance and enjoyment, we offer the following comprehensive benefits package designed for the needs of our full-time team-members:
Flexible work schedules and ability to work remotely available for many roles
Educational Assistant Program
Robust time off plan (21 days of PTO in your first year!)
Paid Volunteer Days
11 paid holidays
12 weeks paid Parental Leave for all new parents
6 weeks paid sabbatical
Health, dental and vision insurance paid up to 80% for employees, dependents, and domestic partners
401(k) with up to 4% match
Stock options
Monthly cell phone stipend
Jeans everyday workplace
Gender neutral bathrooms
And more!
At Aledade, we don t just accept differences, we celebrate them! We strive to attract, develop, and retain highly qualified individuals representing the diverse communities where we live and work. Aledade is committed to creating a diverse environment and is proud to be an equal opportunity employer. Employment policies and decisions at Aledade are based on merit, qualifications, performance, and business needs. All qualified candidates will receive consideration for employment without regard to age, race, color, national origin, gender (including pregnancy, childbirth or medical conditions related to pregnancy or childbirth), gender identity or expression, religion, physical or mental disability, medical condition, legally protected genetic information, marital status, veteran status, or sexual orientation.
Report this job