CVS Health
Cary, North Carolina, United States
Director, Stars and Medicare Risk Adjustment - MidSouth Market
Posted over 1 month ago
Job Description
Job Description
The Director of Medicare Risk Adjusted Revenue/Stars champions a culture committed to excellence quality and coding in Medicare for the MidSouth market (NC, SC, TN).
Identifies and drives an overall local market strategy for quality and coding/documentation performance improvement. Responsible for creating and executing strategies and operational tactics that support the achievement of high quality and Star ratings across the MidSouth Medicare Advantage business. Executes on national quality and risk adjusted revenue (RAR) initiatives at the local level. Conducts data analysis, in conjunction with national tools, to identify opportunities that maximize quality and Stars outcomes. Develops processes, work flows and other materials to document the operational and strategic components of initiatives. Leads cross functional workgroups and partners with local and enterprise colleagues on Network, Clinical and Quality teams. Leverages analytical data to identify and prioritize provider outreach strategies for Stars projects, coding education and Risk Adjustment initiatives. Manages local quality programs and vendors. Ensures successful results in medical record retrieval projects, prospective coding programs, provider education initiatives and dissemination of coding best practices. Coordinates with Engagement Managers and RN program managers in performance management of quality, coding and Star Rating measures in Medicare value based contracts. Engages with clinical team and providers as needed serving as subject matter expert on Star rating measures. Investigates operational issues and works with business partners to implement solutions. Influences change in order to improve performance results, organization effectiveness and/or systems/quality/services. Monitors and trends member complaints, grievances and appeals in the local market and creates local activities to mitigate issues. Produces content for training tools for external partners (e.g. brokers, providers) developed around market needs (CTM drivers, trends).
#LI-HH1
Required Qualifications
10+ years experience with Medicare star ratings, quality, coding and risk adjusted revenue. Certified Coding Specialist. Strong technology skills including Microsoft power point, excel (pivot tables, v lookups), Tableau.
Demonstrated leadership with project management, business process consulting, financial strategic analysis, strategic business planning, and/or risk management consulting. Experience with enterprise-wide and/or cross-functional large scale initiatives with high degree of complexity. Strong analytical skills, with the ability to review and manipulate data to draw conclusions. Ability to think strategically and to translate strategy into measurable goals. Demonstrated relationship management skills at the senior level; capacity to quickly build and maintain credible relationships at varying levels of the organization simultaneously. Communication and presentation skills.
Preferred Qualifications
Demonstrated experience successfully implementing change in complex organizations. Experience presenting to Senior Leadership.
Education
Bachelor's degree or equivalent experience
Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
The Director of Medicare Risk Adjusted Revenue/Stars champions a culture committed to excellence quality and coding in Medicare for the MidSouth market (NC, SC, TN).
Identifies and drives an overall local market strategy for quality and coding/documentation performance improvement. Responsible for creating and executing strategies and operational tactics that support the achievement of high quality and Star ratings across the MidSouth Medicare Advantage business. Executes on national quality and risk adjusted revenue (RAR) initiatives at the local level. Conducts data analysis, in conjunction with national tools, to identify opportunities that maximize quality and Stars outcomes. Develops processes, work flows and other materials to document the operational and strategic components of initiatives. Leads cross functional workgroups and partners with local and enterprise colleagues on Network, Clinical and Quality teams. Leverages analytical data to identify and prioritize provider outreach strategies for Stars projects, coding education and Risk Adjustment initiatives. Manages local quality programs and vendors. Ensures successful results in medical record retrieval projects, prospective coding programs, provider education initiatives and dissemination of coding best practices. Coordinates with Engagement Managers and RN program managers in performance management of quality, coding and Star Rating measures in Medicare value based contracts. Engages with clinical team and providers as needed serving as subject matter expert on Star rating measures. Investigates operational issues and works with business partners to implement solutions. Influences change in order to improve performance results, organization effectiveness and/or systems/quality/services. Monitors and trends member complaints, grievances and appeals in the local market and creates local activities to mitigate issues. Produces content for training tools for external partners (e.g. brokers, providers) developed around market needs (CTM drivers, trends).
#LI-HH1
Required Qualifications
10+ years experience with Medicare star ratings, quality, coding and risk adjusted revenue. Certified Coding Specialist. Strong technology skills including Microsoft power point, excel (pivot tables, v lookups), Tableau.
Demonstrated leadership with project management, business process consulting, financial strategic analysis, strategic business planning, and/or risk management consulting. Experience with enterprise-wide and/or cross-functional large scale initiatives with high degree of complexity. Strong analytical skills, with the ability to review and manipulate data to draw conclusions. Ability to think strategically and to translate strategy into measurable goals. Demonstrated relationship management skills at the senior level; capacity to quickly build and maintain credible relationships at varying levels of the organization simultaneously. Communication and presentation skills.
Preferred Qualifications
Demonstrated experience successfully implementing change in complex organizations. Experience presenting to Senior Leadership.
Education
Bachelor's degree or equivalent experience
Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
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