Regional Manager, Risk Adjustment

Company:
AHI agilon health, inc.

Location:
Charleston, SC

Job Title:
Regional Manager, Risk Adjustment

Job Description:

Position Summary:

The Regional Manager of Risk Adjustment will be accountable for successfully managing the Risk Adjustment program and overseeing the end-to-end execution of the program across multiple Risk Bearing Entities (RBE's) Manages the Risk Adjustment teams and operations in multiple markets and will work to ensure optimal coding accuracy, provider engagement and provider performance in those markets. This person will work across multiple operation teams to develop or improve systems, processes and tools that will help with the identification of diseases, assessment of the diseases and care gaps with proper documentation to ensure accurate submission of information to payer entities. The Regional Manager of Risk Adjustment must also be adept with developing tactics to meet program goals and metrics.

Essential Job Functions:

• Ability to manage the Risk Adjustment program across multiple Risk Bearing Entities or multiple markets within an RBE.
• Manages multiple and large teams that have the potential to be geographically dispersed
• Accountable for the hiring and onboarding of all new Risk Adjustment team members (reviewers, coders, coordinators, etc.)
• Responsible for team assignments, workload, and performance management
• Manages the coding program in the markets regardless of whether coders are agilon badged or leased from provider groups
• Oversees the onboarding and training of Pre-visit Medical Record reviewers and monitoring metrics to determine program needs (i.e., clinical documentation education, auditing, etc.) and engages with Market or BOI Medical Director on next steps
• Participates in the orientation of other market team members by educating them to the BOI program
• Engages with Providers and their office staff on BOI. This includes sharing actionable data with them and driving performance
• Leads efforts to analyze markets performance data and operationalize efforts for improvement if identified
• Oversees the onboarding of any new providers or practices that join the market.
• Assist and support Risk Adjustment Director or designated Market Leader on projects as needed.
• All other duties as assigned

Other Job Functions:

• Understand, adhere to, and implement the Company's policies and procedures.
• Provide excellent customer services skills, including consistently displaying awareness and sensitivity to the needs of internal and/or external clients. Proactively ensuring that these needs are met or exceeded.
• Take personal responsibility for personal growth including acquiring new skills, knowledge, and information.
• Engage in excellent communication which includes listening attentively and speaking professionally.
• Set and complete challenging goals.
• Demonstrate attention to detail and accuracy in work product.
• Ability to travel between multiple locations

Qualifications:

Minimum Experience:

• 6+ years, of experience in managed care or the health care industry
• 4+ years managerial experience
• Experience in Value Based Care
• Proven experience with Program Management
• Experience managing programs across multiple regions
• Must be able to interpret data, derive and operationalize action plans based on data
• Strong Ability to create and maintain documents using Microsoft Office (Word, Excel, Outlook, PowerPoint)
• Advanced proficiency with PowerPoint and Excel.

Education/Licensure:

• Bachelor's degree: or equivalent work experience required.
• Master's degree preferred
• Certified Coder preferred (CCS, CCS-P, CPC)