Habitat Health

Risk

• Review participant medical records and provider documentation to identify, validate, and code risk-adjustable diagnoses in accordance with CMS-HCC v24 and v28 guidelines.
• Ensure complete, accurate, and compliant ICD-10-CM coding with a primary focus on concurrent and retrospective reviews (with flexibility for pre-visit planning as needed).
• Draft and submit compliant provider queries to clarify documentation and support accurate coding.
• Track and follow through on open queries—engaging with providers, monitoring responses, and closing them out appropriately.
• Apply strong critical thinking skills to resolve complex documentation and coding scenarios.
• Maintain clear, professional communication with providers and internal teams to support documentation completeness.
• Stay current with CMS, OIG, and industry regulations related to risk adjustment and coding compliance.
• Support accurate and compliant documentation for PACE participants in a remote environment.

Certified Risk Adjustment Coder

Project Manager

• Lead complex, cross-functional healthcare projects (e.g., EHR implementations, care model redesigns, regulatory compliance initiatives, facility expansions)
• Define project scope, goals, deliverables, and success criteria in collaboration with stakeholders and senior leadership
• Develop detailed project plans, including schedules, budgets, resource plans, and risk assessments
• Facilitate regular project meetings and maintain clear communication with stakeholders
• Ensure projects comply with healthcare regulations such as HIPAA, CMS, and State specific standards
• Monitor project performance using KPIs and report status, issues, and risks to executive leadership
• Drive process improvement and operational excellence in healthcare settings
• Support change management efforts and end-user training in clinical and non-clinical areas
• Conduct project evaluations and assessment of results
• Serve as the primary point of contact for internal and external stakeholders

Senior Project Manager – New Markets

Director

• Design and lead Habitat Health’s provider network strategy from conception through ongoing management, ensuring compliance with PACE, Medicare, and Medicaid regulatory requirements.
• Lead the contracting function, including template design, negotiation strategy, and execution for physicians, hospitals, ancillary providers, and community-based partners.
• Hire, inspire, and manage a growing team focused on provider contracting, credentialing, directory management, and performance oversight.
• Establish and enforce network governance standards, SLAs, and provider performance scorecards to ensure quality, access, and cost-effectiveness.
• Partner closely with PACE Center Leadership, Office of the CMO, Population Health, Finance, Strategy, Growth, and Health Plan Operations to define network priorities and close gaps.
• Develop and oversee value-based and performance-linked contracting models to improve quality and participant outcomes.
• Implement provider engagement strategies, including training, forums, and ongoing relationship management to ensure alignment with our mission and care model.
• Monitor the evolving healthcare landscape, regulatory changes, and market dynamics to identify opportunities for network expansion, innovation, and competitive differentiation.
• Analyze network adequacy data, provider performance metrics, and market trends and present strategic recommendations to leadership.

Network Director

Data Analyst

Partner with clinical ops, finance / actuarial, population health, product, and technology teams to analyze claims, EMR, and operational data to identify trends and opportunities for improved care delivery and cost management
Design, build, and maintain dashboards and reporting pipelines using tools such as Power BI, SQL, dbt, and Azure Data Services
Translate business questions into structured data queries and visualizations that enable leadership to make evidence-based decisions
Collaborate with data engineering to ensure data quality, proper documentation, and alignment with business definitions
Contribute to the design and monitoring of program performance, risk adjustment, utilization, and quality metrics
Support internal and external reporting requirements including PACE-specific measures and CMS regulatory reporting
Help define and evolve data governance and standardization practices in partnership with analytics and engineering teams

Certified Risk Adjustment Coder

Senior Project Manager – New Markets

Network Director

Senior Healthcare Data Analyst