The Sr. Manager, Risk Adjustment & HEDIS is responsible for the oversight, active participation and deliverables of Marketplace Risk Adjustment projects/programs, including EDGE submission, HCC coding and RADV audit. Responsible for the oversight, active participation and deliverables of Marketplace, Medicaid and Medicare Advantage-related HEDIS requirements and analysis, including system submission, ROADMAP and measurement collection, validation and reporting. Responsible for oversight, active participation and deliverables of Marketplace, Medicaid and Medicare Advantage data analytics related to HEDIS and Risk Adjustment to assure accurate and complete quantitative analysis and presentation of analysis results. Additonal responsibilities include:
direct supervision of staff management of both HEDIS and Risk Adjustment programs, including Nurse Auditors, specialists, analytic and clinical staff.
Building and leading cross-functional teams to monitor performance and respond by adjusting strategy and processes where necessary.
Identifying programmatic initiatives required to achieve the organization's goals by working with external and internal partners.
Bachelor's degree required in Business, Health Informatics, Public Health, Nursing, or related discipline
Five years healthcare experience preferably in a managed care organization.
Two years performing quality performance measurement/risk adjustment and/or project management in health care or health plan organization
Two years management experience
Analytical, Mathematics, Medical Terminology, Statistical
Ability to manage complex projects across multiple departments, critical thinking skills
Strong problem-solving, quantitative and analytical skills
Ability to use business intelligence query tools, computer spreadsheet (Excel), and database (Access and others, including Visual Basic) at advanced level
Working knowledge of Structured Query Language (SQL) and Extensible Markup Language (XML) Knowledge of Risk Adjustment reporting and analysis.
Knowledge of Quality Measurement reporting and analysis.
Proven skills in report writing and report development. Dashboard development skills a plus.
Proven skills with data presentation including charts, graphs and other exhibits.
Ability to communicate effectively both orally and in writing
Ability to handle multiple responsibilities and changing priorities
Ability to quickly learn and implement knowledge of new technical processes
Must pay attention to details
Excellent organizational skills
Internal Number: 152171
About Harris Health System
The Harris Health System is a fully integrated healthcare system that cares for all residents of Harris County, Texas. We are the first accredited healthcare institution in Harris County to be designated by the National Committee for Quality Assurance as a Patient-Centered Medical Home, and are one of the largest systems in the country to achieve the quality standard. Our system includes 23 community health centers, five school-based clinics, a dental center and dialysis center, mobile health units, a rehabilitation and specialty hospital and two full-service hospitals.Ben Taub Hospital is a world renowned Level I Trauma Center with 586 licensed acute-care beds and provides a wide range of specialty care outpatient services. Lyndon B. Johnson Hospital is a 328 licensed bed acute-care hospital with a newly expanded Level III trauma center and a distinguished regional center for neonatal intensive care for high-risk deliveries.Harris Health is a teaching system for Baylor College of Medicine and The University of Texas Health Science Center at Houston (UTHealth). We train the next generation of healthcare providers on the latest medical procedures and technological breakthroughs.With... our fully integrated electronic medical records system, we offer patients the convenience and assurance that their medical history is accurate, safe and available when and where it is needed. Our Medical Home designation ensures that we offer a full range of preventive, specialty and acute care services for the entire family.