Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes.
What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be Collaborative.
If you share our passion for changing healthcare so all people can live healthy, brighter lives – apply to join our team.
SCOPE OF ROLE
The Bright Health Risk Adjustment and Coding Team is an integral component of Bright’s success as it defines and ensures outstanding clinical care for our members. As a Risk Adjustment Alternate Submission Manager, you will be responsible for leading processes regarding alternate encounter submissions process, measuring performance against service level agreements, facilitating new plan year readiness, removing obstacles, and the day-to-day facilitation of Bright’s partnerships. This role works across departments, teams, project development offices, and lines of business to deliver a best in class business results under strict regulatory adherence and compliance mindset.
The Risk Adjustment Alternate Submission Manager role major responsibilities include, but it is not limited to these items.
- Own alternative / supplemental encounters submission and deletes process
- Leads vendor relationship and discussion as applied to alternative / supplemental encounters submissions
- Assist with vendor partnership, data transfer, and ROI calculations
- Finds, communicates, and escalates root causes and ad hoc nuances
- Manages metrics with leadership teams on a cyclical basis
- Assists with, tracks, and helps implement risk adjustment related initiatives and strategies
- Seeks, maintains, and builds a best a class encounters knowledgebase
- Relentlessly champions the importance of successful encounters through the lens of payer value
- Authors and updates policies, procedures, and program guides
- Follows, reports, and adheres to all regulatory guidance
- Recruit, hire and train new team members.
- Maintain staffing and scheduling plans to meet departmental objectives as provided by leadership, including meeting specified service levels.
- Monitor and guide team efforts, providing coaching and development to team members.
- This position may have supervisory responsibilities.
EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
- Minimum of a Bachelor’s degree
- Four or more years’ experience in Medicare Advantage, Commercial, and related vendor management and/or business analysis
- Experience with alternative / supplemental encounter submission and deletes process to EDGE and EDS
- Detailed knowledge of Medicare Advantage, Commercial, and related product and timing lifecycle
- Proven focus and ability to communicate Medicare Advantage, Commercial, and related encounter dynamics at an Executive level
- Two or more years’ experience with Risk Adjustment encounter submission management
- Proficient in Microsoft Office Products; Word, Excel, PowerPoint
- Minimum of a Bachelor’s degree in healthcare or technical related field
- Extensive knowledge of risk adjustment models and strategies
- Six or more years’ experience in Medicare Advantage, Commercial, or related healthcare and risk adjustment
- Advanced skills in Microsoft Office Products; Word, Excel, PowerPoint
- Proficiency in SQL, SAS, and or other data aggregation platforms
- Strong written and verbal communication skills
- Strong attention to detail
- Ability to quickly learn and adapt to meet business needs
- Experience working with Risk Adjustment vendors
- Demonstrated knowledge of risk adjustment regulations
- Ability to work independently
- Ability to build relationships with office staff, physicians, and market team
- The majority of work responsibilities are performed in an open office setting, carrying out detailed work sitting at a desk/table and working on the computer.
We’re Making Healthcare Right. Together.
We understand patient pain points, eliminating complexity while increasing transparency, for greater access and easier navigation.
We integrate and align individual incentives at all levels, from financing to optimization to delivery of care.