Managing Dir, Risk Adj Analytics & Encounters

Emergent Holdings • Kalamazoo, MI • 3d ago

SUMMARY: nnThe Managing Director is responsible for planning, organizing, directing, controlling, and leading multiple business units that drive analytics for the company. This position establishes vision and identifies strategic direction for the business units and support corporate goals and objectives. This role will provide analytic forecasting and bid support for our largest client, BCBSM and our Joint Ventures Plans (JVs) in multiple states. This will create a single point of contact for RA analytics reporting that supports Provider Engagement Coordination (PEC), Paper Gaps/Remote Clinical Documentation Improvement (CDI), Risk Mitigation Audits, Submissions and Medicare/Commercial Retrospective services for BCBSM. The Managing Director is accountable for the RA Analytic support provided to BCBSM and our JV partner plan for Medicare Advantage (MA) or government programs as assigned.nnESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned. nn1. Oversees Directors, Actuarial and analytics support staff, and senior technical personnel.nn2. Leads and directs the organization including MA and our JV Partner Plans by providing analytic expertise that drives revenue cycle capital planning decisions for the Chief Actuary, MA President and Executive team or any other Government Programs work as assigned. nn3. Develop, enhance and maintain detailed actuary modeling to support NMAM bid, budget and forecasting cycles, KPI scorecard reporting, settlement and year-end accruals, and executive level reporting and dashboard. nn4. Evaluates and provides performance reporting and insights on prospective, retrospective, and submission/encounter program impacts which drive operation improvements nn5. Supports Actuarial, Finance, HCV, and other teams based on modeling request, RA performance insights for existing or new contract opportunities and ensures alignment and consistent messaging of revenue model results. nn6. Creates, enhances and maintains provider reporting and analytics, including chronic condition persistency/recapture rates, suspecting, targeting, and PO level HCC capture improvement opportunities. nn7. Provides risk adjustment education to external and internal stakeholders including the key accounts, Group, Meaningful Risk providers or as required. nn8. Supports request from RA team that drive insights and improvement opportunities on RA initiatives, Premium Integrity programs, and encounter submission error resolution priority. nn9. Directs the development of corporate standards. nn10. Directs the review of tools and technologies for improving performance and reducing costs. nn11. Works closely with Business Unit Support and with appropriate business areas to ensure that business needs are understood and that services provided meet those needs. nn12. Provides vision, leadership, planning, project coordination, and management for the development of a cost-effective department, while concurrently facilitating efficient operations to meet current and future business needs within the organization. nn13. Represents Company in community and industry, programs, and conferences. nn14. Upon request, functions as the department head in the absence of the executive leader. nn15. Participates in the development of programs as a strategic partner that supports the company plan. nn16. Participates in development of annual departmental budget, monitors budget, and identifies budget discrepancies. Researches cause and makes recommendations. nn17. Responsible for balancing workload to optimize the effectiveness of the department. nnQUALIFICATIONSnnTo perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

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