A bit about us:
Were on a mission to change healthcare how its paid for, delivered, experienced. We want to put people center stage, not process or profit. We are guided by a deep belief that every person on Medicare should be treated like we would treat a member of our own family: with loving care and a profound commitment to their health and well-being.
Thats why were gathering a whole bunch of smart, big-hearted people to create a new kind of healthcare company one that combines compassion, health insurance, clinical care, and technology seamlessly.
"We want to partner with people we love for a cause we believe in. Life is short. Join us."
A bit more about this role:
The risk adjustment manager will help Devoted tackle one of the biggest problems affecting the U.S. healthcare system: the inability to easily and securely share patient clinical data across healthcare organizations. This problem hinders Devoted from accessing our members medical records. The review of medical records is paramount to Devoteds ability to successfully managing our members health conditions, ultimately reducing preventable hospitalizations and improving health outcomes.
On the Risk Adjustment team, we currently tackle this problem through integration with provider EMR systems and/or physical retrieval of charts. The risk adjustment manager will be responsible for developing the teams data acquisition strategy, which includes wide-scale retrieval, transformation, storage, and use of patient medical records across Devoted for care planning, quality, and risk adjustment. Through this work, the manager will also ensure our Clinical Documentation Improvement (CDI), Retrospective Coding, and Program Integrity teams have adequate access to the medical record data essential to their work.
Responsibilities will include:
- Establishing the Risk Adjustment teams data acquisition strategy and medical record library:
- Create and execute on a strategy to gain widespread and, as real-time as possible, access to patient medical records
- Work with Devoteds integrations and product team to design a system for storing and using member medical records across the enterprise
- Manage medical record retrieval campaigns completed by external vendors and/or an internal Devoted team
- Building Devoteds operational capacity to intake provider data and monitor the health of our pre-submission data pipeline
- Work with our product team to build our tool for intaking and processing supplemental encounter and diagnosis data submitted by providers
- Manage the cleaning and uploading of provider supplemental data for the purposes of CMS data submission
- Build KPIs to monitor Devoteds pre-CMS submission data pipeline health (e.g claims clearinghouse monitoring, provider claims submission health, etc.)
- Conduct periodic claims reconciliation with key provider partners prior to CMS data submission sweep periods
- Supporting the integrity of our risk adjustment data:
- Work with our Program Integrity team to establish a protocol for retrieving and submitting necessary medical records to CMS within mandated turnaround times for the purpose of RADV audits
- Ability to understand and work with complexity
- Excellent listener and communicator
- Natural relationship builder and able to work well in a cross functional team environment
- Strong attention to detail; values quality and accuracy
- Pragmatic, data savvy, and deliverable-oriented
Desired skills and experience:
- Ability to work in a fast-paced, start-up culture
- Minimum of 3-4 years experience in healthcare, Medicare Advantage or health plan operations preferred
- Strong project management skills and a true operator
- Familiarity with electronic medical record (EMR) systems
- Track record of success delivering elegant solutions to complex problems
If you love running towards complex challenges and transforming them into solutions, if you want to make a potentially huge impact on many lives, and if you are looking for a disruptive startup with an inspiring and talented team, Devoted Health may be the place for you!
Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoteds Code of Conduct, our company values and the way we do business.
As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.
COVID-19 Vaccination Requirement: Where permitted by applicable law, candidates must have received or be willing to receive the COVID-19 vaccine by date of hire to be considered. The Company will provide reasonable accommodations to qualified employees with disabilities or for a sincerely held religious belief, practice, or observance.