Revenue Integrity Lead Director, Clinical Performance -...
CVS Pharmacy - Harrisburg, PA
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Job DescriptionRI Lead Director, Clinical Performance - MarketHighly visible, national leadership position responsible for developing and driving risk adjustment performance and continuous improvements across Aetna's business units - Medicare, ACA, and Medicaid. Builds a culture focused on compliance and heart at work behaviors through the management of staff that are strategically aligned with the markets to jointly drive RAF performance through the delivery of measurable programs with actionable solutions. Responsibilities: Oversees a team that is jointly accountable for risk adjustment strategy, performance, and results within a designated market(s) Sets strategy and a establishes a path working collectively with the market to improve performance based off data analytics, detailed record review and coding documentation Responsible for identifying and recommending nuanced market risk adjustment strategies and collaboratively executing tactics to focus, maximize and achieve market success, including market referrals Jointly responsible for the development and implementation of provider education strategies and action plans through monitoring provider performance Works with the markets to direct provider interventions and assists physicians and office staff who perform below set metrics/expectations Investigates operational issues that impact market performance - working with business partners to implement solutions Assist with development of educational material as a result of claims data or provider requests Oversight and training for department SMEs and coding and documentation specialist Proven relationship management skills at the senior level; capacity to quickly build and maintain credible relationships at varying levels of the organization, internally & externally Provide weekly and quarterly reports for Senior and Executive Leadership Ensure SOPs and P&Ps are updated annually or developed for new projects Assist with implementation of VBCs and/or other key provider group arrangements Attend, collaborate, and contribute at routine market meetings and check points Recommend and execute on 30 month strategy (ongoing) for risk adjustment success Proven success leading, developing, and inspiring team of direct reports Demonstrated leadership with project management, financial analysis, strategic business planning, and risk management Inspires change to improve results and organizational efficiency related to risk adjustmentRequired QualificationsHealthcare experience 5+ years of experience in risk adjustment, medical coding, and documentation 5-7 years in Management Extensive data analytics experience Polished communication & presentation skills - specific experience addressing Senior Leadership Advanced computer skills Ability to think strategically and to translate strategy into measurable goalsCOVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred Qualifications AAPC, Certified Professional Coder (CPC), preferred (required to obtain 6 months after hire) AAPC, Certified Professional Coder (CRC), preferredEducation RN, preferred Bachelor's Degree in Business Administration/Management, required (6 plus years of relevant work experience in lieu of degree) Master's Degree in Health Administration or Business, preferredBusiness OverviewBring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.
Created: 2024-09-07