SCOPE OF ROLE

Bright Health’s Risk Adjustment Team is working to push boundaries to redefine what strong a strong risk adjustment program can accomplish in health care.  The AVP, Risk Adjustment, is a thought partner to all areas of the Individual and Family Plan (IFP) and Medicare Advantage (MA)businesses and will help define and drive a culture that balances strong clinical engagement, member focus analytic driven decisioning. 

ROLE RESPONSIBILITIES

The AVP, Risk Adjustment job description is intended to point out major responsibilities within the role, but it is not limited to these items

• Provide thought leadership to build a Risk Adjustment function from the ground up, including the creation of an analytics and programmatic capabilities agenda that distinguishes Bright from competitors.
• Provide executive leadership for all national and field based risk adjustment activities for both IFP and MA lines of Business
• Establish a culture focused on care quality based on strong analytics and solid process and controls
• Sets member and provider engagement strategies that meets member care needs while maintain appropriate ROI
• Collaborate with Actuarial and Analytics teams to design and implement suspecting and segmentation strategies for use in prospective and retrospective programs
• Develop short-term, quick-win functionality as well as longer-term, analytics based coding quality programs and tools
• Communicate complex concepts to non-technical business stakeholders across the entire business cycle, from question identification through results interpretation, and including communication about data integrity.
• Build and drive strategies to optimize our insource/outsource approach for RA capabilities
• Collaborate with Bright’s Technology team to ensure that all data and vendor management infrastructure is functioning
• Ensure Bright’s ability to meet compliance reporting requirements for federal and state level regulators on an annual cycle including RADV audits
• Other duties and responsibilities as assigned.

SUPERVISORY RESPONSIBILITIES

This position may have direct and indirect supervisory responsibilities for RA program execution and analytics functions

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

• 10 or more years of experience in a health care Risk Adjustment field required.
• Five (5) or more years leadership experience managing and mentoring large teams with diverse RA competencies
• Working knowledge of business intelligence tools and how they are used to drive business decisions
• Bachelor’s degree in math, engineering, analytics or healthcare related fields, Masters in business, mathematics, statistics or healthcare administration preferred
• Expertise with risk adjustment analytics and vendor management strongly preferred, in both IFP and Medicare LOB’s

PROFESSIONAL COMPETENCIES

• Strong ability to lead and mentor a highly skilled team
• Confident decision maker using both empirical and situational information
• Ability to frame an analysis from end-to-end in collaboration with business and technical stakeholders
• Expertise in the use of advanced data analysis to identify opportunities and design programs to capture value
• Experience managing third party service providers including TPA’s and chart related functions
• Collaborative partner, easy communicator, and careful analyst

WORK ENVIRONMENT

The majority of work responsibilities are performed in an open office setting, carrying out detailed work sitting at a desk/table and working on the computer. Travel may be required.