Description and Requirements

The Director, Risk Score Accuracy will be accountable for activities that drive appropriate revenue and performance of risk score accuracy programs that are critical to the growth and financial viability of all Healthfirst products. This role will work closely with internal subject matter experts to establish and maintain key metrics that measure risk score accuracy program effectiveness. The results of which will be shared with executives and leaders at hospitals, provider groups and used to coordinate program activities between vendors and stake holders.

Hybrid Work Schedule

• This role is hybrid which consists of reporting to our 100 Church Street, NYC office location 3 days per week.

• Assume leadership role in the delivery and execution of the risk adjustment program by driving value through data driven decisions in a regulatory compliant manner.
• Lead regular meetings with internal leaders to review strategy and goals of the program and communicate performance, opportunities, budget versus actual, benchmark analysis to Healthfirst leadership.
• Manage the development and implementation of corporate performance improvement campaigns and initiatives as needed
• Collaborate and engage internal stakeholders such as Actuary, Delivery System Engagement, Information Technology, Product Management to ensure alignment across processes and work effort.
• Provide guidance and thought leadership to analysts and staff in support of all processes related to risk adjustment for Medicaid, Medicare & QHP products.
• Direct the communication of all appropriate changes in CMS and regulatory environment that impact risk scores, benchmark fluctuations and revenue implications.

• Bachelor's degree in actuarial science, Mathematics, Statistics, Finance, or a similar field which demonstrates an affinity and talent for quantitative analysis
• Minimum ten (10) years' experience in a combination of quality, provider engagement and/risk adjustment, with at least 3 years in a senior leadership role
• Demonstrated knowledge of Center for Medicare and Medicaid Services (CMS) practices, policies, and regulations. Expert knowledge of Medicare Risk Adjustment Payment Methodology, HCC, CRG and other risk adjustment methodologies
• Excellent leadership and team management abilities with a history of developing high performing teams
• Experience with managed care software and analytics tools. Effective communication and interpersonal skills, with the ability to influence stakeholders at all levels
• Experience with strategy development, execution, planning, and management of high priority/high visibility projects related to corporate enterprise efforts
• Ability to analyze large data sets, synthesize interpretations and present results findings to internal executive stakeholders
• Prior experience managing a team

• ASA (Associate, Society of Actuaries) membership or on track to become one