This job description refernces Director but we would still love to hear from you if at a Senior Director or VP level.
The Director of Risk Adjustment will be responsible for setting the strategic direction for the revenue accuracy and risk adjustment efforts for all lines of business with risk adjustment (merged market commercial, Medicare Advantage, SCO, PACE, and Medicaid).
Work to enhance our relationships with providers and members to enable these risk optimization efforts. Support activities to access electronic medical records efficiently and effectively.
The position will encourage optimized provider coding through training, reporting, and engagement efforts. Oversee vendor relationships with regards to chart review and in-home assessments for our members.
Work internally to align quality metrics & risk optimization opportunities. Support targeting members for PCP visits and member enrollment efforts.
ABOUT FALLON HEALTH:
Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation’s top health plans, and is accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit www.fallonhealth.org.
Provider Optimization Efforts (40%)
Member Engagement and Optimization Efforts (40%)
Alignment of activities between risk adjustment and clinical quality activities (20%)