"Alerted.org

Description

This position is incentive eligible.

Salary Estimate: $139256.00 - $222768.00 / year

Learn more about the benefits offered ( https://careers.hcahealthcare.com/pages/employee-benefits-and-rewards ) for this job.

The estimate displayed represents the typical salary range of candidates hired. Factors that may be used to determine your actual salary may include your specific skills, how many years of experience you have and comparison to other employees already in this role. The typical candidate is hired below midpoint of the range.

Introduction

Last year alone, HCA Healthcare colleagues invested over 156,000 hours impacting our communities. As a Director of Quality and Risk Adjustment with HCA Healthcare, you can be a manager in an organization that is devoted to giving!

Benefits

HCA Healthcare, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

+ Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.

+ Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.

+ Free counseling services and resources for emotional, physical and financial wellbeing

+ 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)

+ Employee Stock Purchase Plan with 10% off HCA Healthcare stock

+ Family support through fertility and family building benefits with Progyny and adoption assistance.

+ Referral services for child, elder and pet care, home and auto repair, event planning and more

+ Consumer discounts through Abenity and Consumer Discounts

+ Retirement readiness, rollover assistance services and preferred banking partnerships

+ Education assistance (tuition, student loan, certification support, dependent scholarships)

+ Colleague recognition program

+ Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)

+ Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.

Learn more about Employee Benefits (https://careers.hcahealthcare.com/pages/employee-benefits-and-rewards)

_Note: Eligibility for benefits may vary by location._

Come join our team as a Director of Quality and Risk Adjustment. We care for our communities and employees! HCA Hope Fund in fourteen years reached a historic milestone: $50 million in help to our colleagues in need. Last year, HCA Healthcare and our colleagues donated $13.8 million dollars to charitable organizations. Apply Today!

Job Summary and Qualifications

The **Director of Quality and Risk Adjustment** is a key strategic leader responsible for driving performance of the Quality and Risk Adjustment programs. This includes identifying opportunities to improve completeness and accuracy of risk adjustment data submitted to CMS and HHS, and for achieving Quality goals as set forth in health plan agreements. This role is responsible for leading the development, analysis and reporting of key quality and risk adjustment metrics, as well as overseeing analyses of new legislation and regulations and assessing the impact of any changes in the programs.

Major Responsibilities:

+ Partner with executive leadership to plan the strategic direction of Quality and Risk Adjustment programs

+ Using the Cozeva tool, use analytics to define the Risk Adjustment program’s strategy and focus

+ Collaborate with key stakeholders like Network Management to ensure Representatives are armed with actionable data to review with physicians for timely closure of Quality care gaps and annual recapture of HCC conditions

+ Maximize and build internal team competency in Quality and Risk Adjustment analysis; identify trends and develop data-driven insights

+ Lead the design of a compliant documentation education program for network physicians

+ Ensure internal HCC coders meet minimum coding performance guidelines

+ Evaluate and oversee the development and implementation of CMS and HHS Risk Adjustment program changes. Incorporate changes and requirements into strategy and forecasts

+ Lead the collaboration between Risk Adjustment, Quality, Medical Management and Network Management teams as it relates to capturing and managing members’ conditions for the best outcomes

+ Direct the development and validate results of key analytics and data to support Risk Adjustment financial forecasts and performance

+ Develop dashboard reporting to communicate program results to leadership

+ Educate internal and external stakeholders on the critical nature of Quality and Risk Adjustment programs

+ Recommend areas of process improvement and best-practice medical office/physician workflows utilizing EMR and the Cozeva tool

+ Lead and direct effective and compliant Risk Adjustment submission process ensuring submissions are complete and accurate and rejections worked timely

+ Serve as the subject matter expert in projects and initiatives and drive Risk Adjustment and Quality program best-practices across all lines of business

+ Develop and direct employee training and provider outreach programs to improve Risk Adjustment and Quality program performance

+ Ensure compliance with all timekeeping policies for staff within the department

+ Ensure staff is compliant and timely with all mandatory education and Healthstream trainings

Strategic Relationships:

+ Develops and strengthens collaborative relationships with Division and Corporate leaders to advance the care of our patients

+ Actively encourages collaboration and possesses excellent interpersonal skills in building and maintaining crucial relationships

+ Delivers information in a clear, concise and compelling manner

+ Delivers targeted and actionable communications that invites two-way professional communication. Adjusts messages appropriately by audience

+ Demonstrates a willingness and ability to lead others

Self-Development:

+ Maintains current knowledge of CMS program rules for Risk Adjustment Maintains current knowledge for HEDIS and other standard Quality metrics required by CMS or health plans Demonstrates proficiency in current and emerging technologies

+ Simultaneously uses multiple technologies

+ Independently takes proactive steps toward problem resolution

+ Completes all mandatory and assigned education by established deadlines

Experience & Education:

+ Bachelor's degree in business or healthcare related field Required

+ 5+ years leading Risk Adjustment and Quality programs Required

+ Experience at Manager or Director level Required

+ Experience with Quality and Risk Adjustment programs in health plans or MSO/IPAs Required

+ Demonstrated success improving Risk Adjustment performance and processes Required

+ Demonstrated success leading cross-functional teams Required

+ Ability to plan and prioritize tasks to meet all data submission deadlines Required

+ Experience using Cozeva Required

+ Certified HCC Coding Specialist Required

+ Certified Professional Coder Required

+ Certified Quality Specialist Preferred

Physician Services Group (https://careers.hcahealthcare.com/pages/physician-services) is skilled in physician employment, practice and urgent care operations. We are experts in hospitalist integration, and graduate medical education. We lead more than 1,300 physician practices and 170+ urgent care centers. We are HCA Healthcare’s graduate medical education leader. We provide direction for over 260 exceptional resident and fellowship programs. We focus on carrying out value-added solutions. These solutions help physicians deliver patient-centered healthcare. We support HCA Healthcare's commitment to the care and improvement of human life.

HCA Healthcare has been recognized as one of the World’s Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.

"The great hospitals will always put the patient and the patient's family first, and the really great institutions will provide care with warmth, compassion, and dignity for the individual."- Dr. Thomas Frist, Sr.

HCA Healthcare Co-Founder

Become a manager with an organization that invests in your career while giving to the community. We are seeking distinguished applicants for our Director of Quality and Risk Adjustment opening. Help HCA Healthcare create healthier tomorrows for patients and communities.

We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.