Are you ready to lend your talents, unique perspective, and
awesome ideas to help us change how kidney care is being delivered?
As the Senior Manage r of Financial Performance , you
will play an active role in leading continuous process improvement
initiatives for risk adjustment operations and financial
performance. We are looking for someone with strong experience in
roles that intersect both technology and operations (previous
experience in Medicare Risk Adjustment is highly preferred). This
role is responsible for driving quality and performance excellence
and providing process support for risk adjustment operations and
financial performance improvement initiatives.
Be a key contributor and partner in the oversight of the risk
adjustment operations, including member engagement tracking, coding
and documentation, data submissions, financial impact modeling, and
Be an active participant and support for the risk adjustment and
quality leadership and production staff.
Support and assist in implementation of new risk adjustment and
payer quality programs.
Act as the risk adjustment coding and quality subject matter
Oversee risk adjustment coding and quality staff, and peer
review nurse qualification standards and staff selection.
Conduct training sessions and job shadowing of vendor coding
teams to identify coding efficiencies, software improvements,
clinical documentation improvement opportunities, etc. in
compliance with industry accepted best practices .
Provide regular leadership and project team reporting for
current state and planned initiatives .
Assist and provide suggestions in the design and implementation
of a comprehensive risk adjustment and coding reporting program;
including the identification of opportunities for complete capture
of patients' current risk.
Address client escalations regarding relevant workflows.
Participate and chair committees aligned with risk adjustment
Provides guidance for programs involving population health.
Work closely with internal stakeholders on identifying,
modeling, and implementing initiatives and/or opportunities.
Participates in the discovery, evaluation, and solutioning of
new clinical services.
Provides analytical support in understanding and evaluating cost
and benefit of various business proposals, and the profitability of
various service areas or line of business within the region for
critical decision making .
Develop financial models to support various risk adjustment or
performance initiative related decisions .
Align business and clinical objectives related to risk
adjustment and quality workflows.
Support documenting, updating, and implementing new operational
related to operations management, success measures , and
identification of value-add and opportunities.
Provides clinical and industry thought leadership for marketing
Healthcare experience required.
Minimum three (3) years of analytical experience required.
Strategic planning or consulting experience required.
Demonstrated ability to communicate effectively with all levels
of the organization.
Exceptional critical thinking and analytic skills.
Exceptional verbal and written communication skills, ability to
deliver executive-level presentations.
Ability to lead project teams and act as team player .
Proven track record of project management skills, successful
execution of key organizational initiatives.
Demonstrated creativity in identifying and implementing
solutions to complex, ambiguous issues.
You have the ability to partner in the development,
management and operationalizing processes and workflows to maximize
You understand how critical Risk Adjustment operations are and
seek to drive improvement and innovation in this area.
Demonstrated knowledge in leadership, collaboration, and
Experience with Medicare Advantage, Affordable Care Act, or
Medicaid risk adjustment programs and CMS regulatory guidance
Medicare Advantage Risk Adjustment HCC coding experience
A current coding certification recognized by AAPC, AHIMA or
other nationally recognized coding certification, preferred to hold
a CRC certification.
Two years of healthcare experience preferred.
Master's in Business Administration, Health Care Administration,
or related field preferred.
Please note this job description is not designed to cover or
contain a comprehensive listing of activities, duties or
responsibilities that are required of the employee for this job.
Duties, responsibilities and activities may change at any time with
or without notice.
Reasonable accommodations may be made to enable individuals with
disabilities to perform the essential functions .
Somatus, Inc. provides equal employment opportunity to all
individuals regardless of their race, color, creed, religion,
gender, age, sexual orientation, national origin, disability,
veteran status, or any other characteristic protected by state,
federal, or local law. Further, the company takes affirmative
action to ensure that applicants are employed, and employees are
treated during employment without regard to any of these
characteristics. Discrimination of any type will not be
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