Risk

• Develop, manage, and execute Capital’s Risk Adjustment Program Coding and Chart Retrieval operations strategy and initiatives
• Provide strategic and tactical direction in collaboration with the Stars & Risk Adjustment Sr. Director and Medical Director
• Function as a Risk Adjustment subject matter expert and perform analysis and market research
• Manage work plans, cross-functional team collaboration, and implementation of standards, controls, tactics, initiatives, and systems
• Lead coding and chart retrieval teams to ensure required accuracy and efficiency through quality assurance processes and controls
• Lead risk mitigation and HCC compliance audits and ongoing activities
• Drive execution of Risk Adjustment projects including Retrospective and Prospective Medical Records Review and Risk Adjustment Data Validation (RADV)
• Manage process flow, project management, vendor execution and oversight, data submission and reconciliation with stakeholders
• Create, implement, and monitor policies, procedures, SOPs, performance guarantees, and workflows
• Maintain an up-to-date repository of Coding and Chart Retrieval documents
• Collaborate with Actuarial to project and monitor coding program impact on revenue and financial forecasts
• Coordinate processes and data flow between coding/chart retrieval teams and business partners to support follow up of care and quality activities
• Build relationships with internal teams, provider network, vendors, and customers; participate in engagement activities
• Prepare materials, analysis, reports, and presentations for committees, performance meetings, trainings, and newsletters
• Lead, develop, mentor, and manage the Risk Adjustment Coding and Chart Retrieval team
• May require travel to provider offices as necessary

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