Director of Risk Management
Company: MetroPlus Health Plan
Location: Hartford
Posted on: April 4, 2021
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Job Description:
About NYC Health + HospitalsMetroPlus Health Plan provides the
highest quality healthcare services to residents of Bronx,
Brooklyn, Manhattan, Queens and Staten Island through a
comprehensive list of products, including, but not limited to, New
York State Medicaid Managed Care, Medicare, Child Health Plus,
Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc.
As a wholly-owned subsidiary of NYC Health + Hospitals, the largest
public health system in the United States, MetroPlus' network
includes over 27,000 primary care providers, specialists and
participating clinics. For more than 30 years, MetroPlus has been
committed to building strong relationships with its members and
providers to enable New Yorkers to live their healthiest
life.Position OverviewThis is a new and evolving position within
the plan where we are seeking to maximize our efficiency as it
pertains to risk. Responsible for the implementation, oversight and
ongoing execution of risk related activities as it pertains to both
Federal and State risk models across various products offered by
the plan. This position will manage risk processes and will work
alongside a range of business units to ensure that the plan's
populations are accurately represented via the applicable risk
program and work towards addressing any obstacles. Responsible for
collaborating with our network for education and support of
appropriate coding down to the individual practice level. Plans,
actions and progress to be reported at various levels including
executive staff.Job Description* Individual will own the spectrum
of risk activities such as managing workplans and activities across
the plan.* Oversee day-to-day operational needs pertaining to
encounter submission and risk adjustment activities (file
transfers, error reporting, issue resolution).* Devise and
implement strategies related to risk as it pertains to the
methodologies in practice by NY State (CRG), Medicare (HCC) and ACA
(HCC) products.* Incorporate best practices to optimize risk scores
and develop reporting dashboards and KPIs to ensure appropriate
oversight and visibility.* Work amongst various departments to
identify, document and enhance existing processes that impact
risk.* Assess and build initiatives specific to the needs/gaps
found in our provider network as it pertains to appropriate coding
practices.* Manage and engage multiple vendors/contracts who
provide risk services, ensuring their support and effective
outcomes.* Participates in the selection of appropriate risk
vendor(s)/service(s) as needed.* Continuously support reporting and
progress to both internal staff, including executives, as well as
external providers.* Responsible for the timely and accurate
submission of risk data via the NYS APD submission, ACA EDGE
submission and CMS RAPS/EDPS submission processes* Provides support
for any audits internal or otherwise (eg. RADV, Article 44) as it
pertains to risk.* Create and operationalize policies and
procedures for risk.* Ad-hoc reporting and support tasks.Minimum
Qualifications* Experience with the various risk methodologies from
NY State and Federal programs.* Eagerness to learn, develop and own
new processes from the ground up.* Knowledge of regulatory and
submission requirements for each risk program (APD, EDGE,
EPDS/RAPS).* Ability to build custom strategies based on experience
and knowledge.* Strong communications skills.* 3-5 years'
experience in risk adjustment as a business analyst or other
role.Professional Competencies* Integrity and Trust* Customer
Focus* Functional/Technical skills* Written/Oral Communication
Keywords: MetroPlus Health Plan, Hartford , Director of Risk Management, Executive , Hartford, Connecticut
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