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Senior Manager of Financial Performance

Company: Somatus
Location: McLean
Posted on: September 17, 2020

Job Description:

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.

RESPONSIBILITIES:

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 vendor oversight.

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 expert.

Oversee risk adjustment coding and quality staff, and peer review nurse qualification standards and staff selection.

Reporting

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 .

Process Updates

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 and quality.

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 new opportunities.

Q UALIFICATIONS:

Requirements:

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 efficiencies.

You understand how critical Risk Adjustment operations are and seek to drive improvement and innovation in this area.

Demonstrated knowledge in leadership, collaboration, and performance/process improvement.

Preferred:

Experience with Medicare Advantage, Affordable Care Act, or Medicaid risk adjustment programs  and CMS regulatory guidance  in healthcare

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.

OTHER DUTIES:

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 tolerated.

Are you located locally or willing to relocate?  *

Yes, I currently live within commuting distance.

Yes, I am planning to relocate.

No, I am not wiling to relocate.

Are you authorized to work in the United States for any employer?  *

--

Will you now or in the future require visa sponsorship?  *

--

U.S. Equal Opportunity Employment Information (Completion is voluntary) Individuals seeking employment at Somatus are considered without regards to race, color, religion, national origin, age, sex, marital status, ancestry, physical or mental disability, veteran status, gender identity, or sexual orientation. You are being given the opportunity to provide the following information in order to help us comply with federal and state Equal Employment Opportunity/Affirmative Action record keeping, reporting, and other legal requirements.

Completion of the form is entirely voluntary . Whatever your decision, it will not be considered in the hiring process or thereafter. Any information that you do provide will be recorded and maintained in a confidential file.

Gender Please select Are you Hispanic/Latino? Please select Please identify your race Please select Race & Ethnicity Definitions If you believe you belong to any of the categories of protected veterans listed below, please indicate by making the appropriate selection. As a government contractor subject to Vietnam Era Veterans Readjustment Assistance Act (VEVRAA), we request this information in order to measure the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA. Classification of protected categories is as follows:

A "disabled veteran" is one of the following: a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or a person who was discharged or released from active duty because of a service-connected disability.

A "recently separated veteran" means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.

An "active duty wartime or campaign badge veteran" means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.

An "Armed forces service medal veteran" means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.

Veteran Status Please select Form CC-305

OMB Control Number 1250-0005

Expires 05/31/2023

Voluntary Self-Identification of Disability Why are you being asked to complete this form? We are a federal contractor or subcontractor required by law to provide equal employment opportunity to qualified people with disabilities. We are also required to measure our progress toward having at least 7% of our workforce be individuals with disabilities. To do this, we must ask applicants and employees if they have a disability or have ever had a disability. Because a person may become disabled at any time, we ask all of our employees to update their information at least every five years.

Identifying yourself as an individual with a disability is voluntary, and we hope that you will choose to do so. Your answer will be maintained confidentially and not be seen by selecting officials or anyone else involved in making personnel decisions. Completing the form will not negatively impact you in any way, regardless of whether you have self-identified in the past. For more information about this form or the equal employment obligations of federal contractors under Section 503 of the Rehabilitation Act, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp .

How do you know if you have a disability? You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition.

Disabilities include, but are not limited to:

Autism

Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, or HIV/AIDS

Blind or low vision

Cancer

Cardiovascular or heart disease

Celiac disease

Cerebral palsy

Deaf or hard of hearing

Depression or anxiety

Diabetes

Epilepsy

Gastrointestinal disorders, for example, Crohn's Disease, or irritable bowel syndrome

Intellectual disability

Missing limbs or partially missing limbs

Nervous system condition for example, migraine headaches, Parkinson’s disease, or Multiple sclerosis (MS)

Psychiatric condition, for example, bipolar disorder, schizophrenia, PTSD, or major depression

Disability Status Please select 1 Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor's Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp .

PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.

Keywords: Somatus, Washington DC , Senior Manager of Financial Performance, Other , McLean, DC

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