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Director, Risk Adjustment
Clinical Operations
Remote - US
Full Time

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Title/Position: Director, Risk Adjustment 

Department or Business Unit: Population Health

Reporting Structure: VP, Value-Based Operations

Employment Type: FTE

Exemption Status: EXEMPT

Min. Experience: Senior-Level

Travel Required: Some


Overview of the Role:


The Director, Risk Adjustment is responsible for overseeing Privia Health’s national Risk Adjustment (RA) strategy and capabilities. They are responsible for strategic direction, development, and implementation of risk adjustment programs. The Director will build a long term vision and implement strategic initiatives with teams in and outside of Privia Health to drive Risk Adjustment success. The Director will be directly responsible for providing leadership, planning and guidance to markets. They will work closely with all markets to build operational action plans and execute to goals, integrating with other relevant teams, such as Population Health, Analytics, and Performance.


Primary Job Duties: 


  • Accountable for strategy and operations of national RA programs, including: Coding Services, Risk Gaps, and Provider Training
  • Oversee market-based operations as it relates to risk adjustment, collaborating with Market teams on executing their programs
  • Internal subject matter expert and escalation point for RA
  • Implement risk adjustment programs in new markets 
  • Facilitate sharing across markets and drive common goals nationally
  • Lead development of centralized training programs, such as webinars, recorded trainings, and/or training materials to support providers in risk adjustment
  • Collaborate with physician leadership across the organization to ensure RA programs meet physician needs
  • Collaborate with the Population Health, Analytics and Performance teams to develop the appropriate strategy and programs
  • Collaborate with Analytics to understand performance at a National, Market, physician practice, and provider level to identify opportunities for improvement
  • Collaborate with Technology and Clinical IT to improve the EHR and related technology
  • Collaborate with external payer team members on strategies related to RA
  • Collaborate with vendors providing risk adjustments services or technology
  • Accurately follow documentation and coding guidelines and legal requirements to ensure compliance with federal and state regulatory bodies
  • Perform other related duties, which may be inclusive, but not listed in the job description


Minimum Qualifications:


  • Bachelor’s degree required; advanced degree preferred
  • Seven-plus years of relevant experience as a senior leader working in health plans, health systems, and/or provider organizations, within Risk Adjustment
  • Experience in Medicare Advantage or other government programs
  • Experience building and running Risk Adjustment programs
  • Experience with and deep knowledge of the CMS HCC Risk Adjustment model
  • Ability to work closely with providers to collaborate on initiatives and influence decisions
  • Analytical and quantitative mindset
  • Comfortable working in a collaborative, fast-paced, tech-enabled and consensus-building environment with the ability to work with a variety of key constituents
  • Must comply with HIPAA rules and regulations 


Physical Demands and Workplace Environment:


The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Having a high level of interaction with internal employees and external clients. Often working indoors, varying hours based on demand of work. The employee is regularly required to sit, talk, type and hear.


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