Vice President of Risk Stratification, Remote

Responsibilities:

• Drives an evidence-based, data-driven approach to promote core process fidelity and success in Medicare Advantage contracts, especially complete and accurate risk stratification.
• Oversees and manages Clinical Documentation Integrity and Risk Adjustment Teams.
• Drives industry best practices and performance results focusing on driving key KPIs across all contracts, i.e., # visits, RAF score, complete and accurate diagnosis coding to the highest degree of specificity, thorough and accurate documentation, including, where appropriate, diagnoses recapture rates, diagnoses re-submissions, etc.
• Develops a roadmap that defines the path to operationalize specific actions which are repeatable, measurable, and cost-effective.  Collaborates with the analytics team to measure the effectiveness of initiatives and process improvements.
• Ensures complete and accurate documentation practices are in place for all clinics, including audit preparation.
• Collaborates with payer partners, for example, implementing a process to ensure all diagnosis codes submitted are received, ensuring receipt of MAO-004 and MAO-002 files, reviewing RAF accrual models, etc.
• Ensures analytics receives and consumes all available data sources from health plans. 
• Assists provider engagement as well as field and operations teams to optimize workflows within provider conducted patient visits so that the complete and accurate coding of diagnoses are documented in the medical record of the visit. 
• Oversees auditors and auditing practices such as implementing an internal QA process for diagnosis coding and documentation as well as liaising between health plan risk adjustment auditors and Aledade practices.
• Ensures the highest levels of regulatory compliant behavior within the company and with our partner practices.

Qualification Requirements:

• Required: Bachelor’s Degree with 10+ years experience in healthcare. Ideal candidates will have a combination of senior-level experience and expertise in health care strategy, health plans, business development, management consulting, health care finance, and provider operations.
• Preferred: Master’s degree or other advanced degree(s) in business, health administration and/or public policy, or other relevant fields.
• 5+ years of successfully leading and executing a comprehensive Risk Adjustment program at scale
• Proven track record of working collaboratively with clinical and operational colleagues across the organization
• Ability to manage multiple deadlines
• Ability to communicate effectively and sensitively with clinicians and care teams in stressful situations
• Ability to lead by influence to engage colleagues and lead teams cross-functionally
• Experience in fostering networks internally and externally